CITY OF JASPER
2006 APPLICATION FOR SUMMER/SEASONAL/PART-TIME EMPLOYMENT/INTERNSHIP For P/S Only
CITY OF JASPER DEPARTMENTS
P.O. Box 29 – 610 Main Street – Jasper, IN 47547-0029 Dept. Head Only
**ALL QUESTIONS MUST BE COMPLETED “IN INK” BY THE APPLICANT**
Name ________________________________________________________________________________ Title: ___________________________
(Last) (First) (Middle) (Mr., Ms., Mrs., Miss, etc.)
S/S Number __________ - __________ - __________ Date of Birth (If under 18 yrs. of age) ______/______/______
Address_________________________________________________ Telephone (____)___________________Cell (____) ___________________
City ____________________________________________ State_________________________________ Zip_____________________________
Requested Start Date _________________________________________ Expected End Date __________________________________________
In case of emergency, notify:
Name: ___________________________ (Relationship:)_________________ Address______________________________ Phone: _______________________________
Can you furnish a work permit if required? _____ Yes _____ No Driver’s license number (If applicable) # _____________________
Have you ever been employed here before? _____ Yes _____ No
If yes, give position held and dates _________________________________________________ From _____/_____/_____ To _____/_____/_____
Position Desired: In what areas do you want to be considered for employment? Indicate your preference by checking ALL areas interested in:
(Note: Open Positions may not necessarily be available in all categories listed below.)
____ Park Maintenance ____ Swimming Pool Lifeguard ____ Park Special Events ____ Electric Department.
____ Golf Course Pro Shop ____ Swimming Pool Concession Stand ____ Street Department ____ Wastewater Treatment Dept.
____ Golf Course Maintenance ____ Preschool Camp ____ Gas & Water Department ____ Jasper Arts Dept.
____ Swimming Pool Mgr. or Asst. Mgr. ____ Exceptional Camp – Camp Care ____ ALL/Other ___________________________________
____ Internship (Field of Study:___________________________________________________________)
Skills & Qualifications: Summarize any special training, skills, or characteristics that may qualify you to perform job related functions for the position which you are applying.
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
EMPLOYMENT HISTORY
INSTRUCTIONS: Provide the following information of your past and current employers (Excluding City of Jasper Departments).
It is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from
the City of Jasper’s service if I have been employed. I understand I am being considered for employment by the City of Jasper in a temporary capacity only and for
such time as my services are required. I understand this temporary employment does not entitle me to any special consideration for permanent employment. I further
understand that my temporary employment may be terminated by the City of Jasper at any time, without resort to the handbook disciplinary procedures set forth for
permanent employees. I also understand that I am not eligible to participate in any fringe benefit programs except those statutorily required. I give the employer the
right to investigate all references, past and present employers, and to secure additional organizations for furnishing such information. I understand it is the City of
Jasper’s policy not to refuse to hire a qualified individual with a disability because of this person’s need for an accommodation that would be required by the ADA.
_____________________________________________________________________________________ _______________________________________
APPLICANT’S SIGNATURE DATE
RETURN APPLICATIONS TO:
Personnel Director, c/o EOE #CWPT-2022 P.O. Box 29 – 610 Main St. Jasper, IN 47547-0029
Or email to: hra@jasperindiana.gov
SA: SHARED/Applications-CWPT All Depts.doc(revised 11/2021)
