Fillable CITY OF DOUGLAS Employment Application An Affirmative Action

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CITY OF DOUGLAS Employment Application An Affirmative Action

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The CITY OF DOUGLAS Employment Application An Affirmative Action form is 6 pages long and contains:

1 signature
5 check-boxes
158 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Douglas

BROWSE CITY OF DOUGLAS (AZ) FORMS

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The City of Douglas does not discriminate on the basis of Race, Color, National Origin, Sex, Religion, Age, Veteran Status, Genetics or Disability or any other

legally protected status in employment or the provision of services.

Your signed application can only be accepted in hard copy form. Please submit your completed application to:

City of Douglas HR Department

Fax: (520) 417-7155

425 10

Street, Douglas, AZ 85607

Tel: (520) 417-7326

Position Desired

Position Title:

Job Announcement Number:

Type of Position you are interested in: Full Time Part Time Temporary

Seasonal Weekends Shifts

When would you be available to start work?

Personal Data

Name:

Address:

City: State: Zip:

Mailing Address (If different from above)

Home Phone:

Office Phone:

Message Phone:

Cell Phone:

Email Address:

Driver’s License/CDL No. & State: Class:

Expiration:

If CDL, list all endorsements

Endorsements:

Are you legally authorized to work in the United States? Yes No

Have you ever worked or volunteered for the City of Douglas? Yes No

If yes, please give dates:

If you answered yes to the above question, and you were employed under a different name, please list the name

used:

Are any of your relatives employed by the City of Douglas? Yes No

Explain:

Rev. 12/28/2018

CITY OF DOUGLAS

Employment Application

An affirmative action and equal opportunity employer.

CITY OF DOUGLAS

Employment Application

Education

Do you have a High School Diploma accredited in the U.S.? ______Yes ______ No

If yes, give

name and place of school of graduation:

Do you have a G.E.D. certificate? Yes No

College(s) or University

Name and Location

Major

Degree

Date

Business/Vocational/Technical Schools

Name and Location

Course of Study

Diploma & Date

List License (date & #), professional registrations (date), certificates and professional memberships:

List Honors, Awards, Fellowships:

Skills Overview

Approximate Typing Speed in words per minute:

List computer software with which you are familiar:

List all languages you can speak, read,

write and understand to include English.

Language(s):

Speak:%

Read:%

Write: %

Please summarize relevant skills and experience that exemplify your qualifications for the above position:

References:

Give name, address and telephone number of three references who are not related to you.

CITY OF DOUGLAS

Employment Application

Employment History

Current or most recent employer: Phone:

Address:

Your Title: Number of workers you directly supervised:

Employment Dates From: To:

Supervisor’s name/title:

Starting Salary: Present/Ending: Hours per week:

Description of Duties:

Reason for leaving or wanting to change:

Employer:

Phone:

Address:

Your Title: Number of workers you directly supervised:

Employment Dates From: To:

Supervisor’s name/title:

Starting Salary: Ending: Hours per week:

Description of Duties:

Reason for leaving or wanting to change:

Employer:

Phone:

Address:

Your Title: Number of workers you directly supervised:

Employment Dates From: To:

Supervisor’s name/title:

Starting Salary: Ending: Hours per week:

Description of Duties:

Reason for leaving or wanting to change:

CITY OF DOUGLAS

Employment Application

Employment History

Employer: Phone:

Address:

Your Title: Number of workers you directly supervised:

Employment Dates From: To:

Supervisor’s name/title:

Starting Salary: Ending: Hours per week:

Description of Duties:

Reason for leaving or wanting to change:

Employer:

Phone:

Address:

Your Title:

Number of workers y

ou directly supervised:

Employment Dates From:

To:

Supervisor’s name/title:

Starting Salary:

Ending:

Hours per week:

Description of Duties:

Reason for leaving or wanting to change:

Employer:

Phone:

Address:

Your Title:

Number of workers you

directly supervised:

Employment Dates From:

To:

Supervisor’s name/title:

Starting Salary:

Ending:

Hours per week:

Description of Duties:

Reason for leaving or wanting to change:

CITY OF DOUGLAS

Employment Application

Affirmation Statement/Signature

The above information is true and complete. I understand that false statements on this application or any verbal or written

misleading or false representation made in the course of the selection process may be deemed sufficient cause for

dismissal.

In compliance with the Immigration Reform & Control Act of 1986, I will submit proof of work eligibility if hired by the City of

Douglas.

Signature: ______________________________________________________________ Date: ______________________

For Human Resource Department Use Only

MQs

Yes No

T&E Score

Code

Temporary/Limited/Seasonal

Placed on hiring list

Yes No

Notified of Status

Yes No

Notes:

___________________________________________________________________________________

________________________________________________________________________

___________

___________________________________________________________________________________

_______________________________________________________________________________

____

___________________________________________________________________________________

___

________________________________________________________________________________

___________________________________________________________________________________

__________

_________________________________________________________________________

click to sign

signature

click to edit

CITY OF DOUGLAS

Employment Application

APPLICANT INFORMATION SURVEY

Instructions: The City of Douglas is an Equal Opportunity Employer. The information solicited on this page is being

compiled by the City of Douglas HR Department to comply with Federal EEO/Affirmative Action record keeping regulations

and to enable related statistical research. You are not required to furnish this information, but your cooperation is

encouraged. The information provided on this form is CONFIDENTIAL. This survey will be removed from your application

prior to the review process.

Date:

Position Title:

Job Announcement Number:

Indicate your choice of responses for items A - F by placing an X in the appropriate box.

A. Ethnic Category:

Check only one (definition of categories are below.)

White (WH) African American (BL)

Hispanic (HI) Asian (AS)

Native American (AI)

B. Sex

Male (M) Female (F)

C. Age Group

Under 20 (19) 20-29 (20)

30-39 (30) 40-49 (40)

50-59 (50) 60+ (60)

D. Veteran Status

I am a veteran of the United I am not a veteran. (2)

States Armed Forces, honorably separated

following more than 180 days of active duty.

Excluding training and reserve duty. (1)

I am a spouse of a I am the spouse of an Active

permanently disabled veteran. (3) duty Armed Forces member who is missing in action.(4)

E. Are you disabled? (For definition of “disabled” see below.)

Yes (1) No (2)

CITY OF DOUGLAS

Employment Application

EQUAL EMPLOYMENT OPPORTUNITY SURVEY DEFINITIONS

1. White: Includes persons having origins in any of the original peoples of Europe, North Africa, the Middle East, or the

East Indian Subcontinents.

2. Black: Includes persons having origins in any of the Black racial groups.

3. Hispanic: Includes persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture

or origin, regardless of race.

4. American Indian or Alaskan Native: Includes persons having origin in any of the original peoples of North

America.

5. Asian or Pacific Islander: Includes persons having origins in any of the original peoples of the Far East,

Southeast Asia or the Pacific Islands (China, Japan, Korea, Samoa, etc.)

6. Disabled: Anyone who has a physical or mental impairment which substantially limits one or more major life

activities or has a record of such impairment or is regarded as having such an impairment.

Fillable CITY OF DOUGLAS Employment Application An Affirmative Action

Fill Online, Printable, Fillable, Blank CITY OF DOUGLAS Employment Application An Affirmative Action Form

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