Fillable CITY OF MANCHESTER APPLICATION FOR EMPLOYMENT (City of Manchester)

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CITY OF MANCHESTER APPLICATION FOR EMPLOYMENT (City of Manchester)

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U.S.A. forms for City of Manchester

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CITY OF MANCHESTER
14318 Manchester Road
Manchester, MO 63011
636-227-1385 • 636-227-5438 (fax)
APPLICATION FOR EMPLOYMENT
TO APPLICANT: We deeply appreciate your interest in employment in our city. Thank you for taking the time to complete this
application.
The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin. Federal law
also prohibits other types of discrimination such as age, citizenship, veteran status, attainment of benefits, and participation in union
activities. The law of most states and many localities also prohibit some or all of the above types of discrimination as well as some
additional types including, but not limited to, discrimination based upon ancestry, marital status, parental status, sexual orientation, or
source of income. The Fair Credit Reporting Act imposes restrictions with respect to credit data. This list, however, is not exhaustive
of the grounds on which discrimination is prohibited.
(Please Print Clearly)
PERSONAL
Name ________________________________________________________________________
Last First Middle
Social Security No. __________________________________ Telephone No. _______________________________
Address _________________________________________________________________________________________
No. Street City State Zip
E
mail Address ____________________________________________________________________________________
Are you legally eligible for employment in the U.S.A.? Yes ____ No ____ If no, hire is subject to verification that you are of
minimum legal age.
A
re you over the age of 18? Yes ___ No ___ If no, hire is subject to verification that you are of minimum legal age.
P
osition(s) applied for ______________________________________________________________________________
Were you previously employed by us? Yes ______ No ______ If yes, when? ________________________________
If your application is considered favorably, on what date will you be available for work? ___________________________
Are there any other job related experiences, skills, or qualifications which will be of benefit in the job for which you are
applying?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
EMPLOYMENT HISTORY
List below present and past employment, beginning with your most recent
Most Recent Employer - #1
Name and Address of Company
and Type of Business
From
To
Weekly
Starting
Salary
Weekly
Last
Salary
Reason for
Leaving
Name of
Supervisor
Mo.
Yr.
Mo.
Yr.
Telephone
#2
Name and Address of Company
and Type of Business
From
To
Weekly
Starting
Salary
Weekly
Last
Salary
Reason for
Leaving
Name of
Supervisor
Mo.
Yr.
Mo.
Yr.
Telephone
#3
Name and Address of Company
and Type of Business
From
To
Weekly
Starting
Salary
Weekly
Last
Salary
Reason for
Leaving
Name of
Supervisor
Mo.
Yr.
Mo.
Yr.
Telephone
#4
Name and Address of Company
and Type of Business
From
To
Weekly
Starting
Salary
Weekly
Last
Salary
Reason for
Leaving
Name of
Supervisor
Mo.
Yr.
Mo.
Yr.
Telephone
I hereby give permission to contact the employers listed above concerning my prior work experience as indicated below.
Employer #1? Yes ______ No ______
Employer #2? Yes ______ No ______
Employer #3? Yes ______ No ______
Employer #4? Yes ______ No ______
Signed _________________________________________
RECORD OF EDUCATION
School
Name & Address of School
Course of Study
Circle Last
Year
Completed
Did You
Graduate?
List
Diploma
or Degree
Elementary
5
6
7
8
Yes
No
High
1
2
3
4
Yes
No
College
1
2
3
4
Yes
No
Other
(specify)
1
2
3
4
Yes
No
PERSONAL REFERENCES (Not Former Employers or Relatives)
Name and Occupation
Address
Phone Number
May we telephone you to follow up on this application at home? Yes _____ No _____
If yes, what is the best time to call? ______________________________________________________________________________
May we telephone you to follow up on this application at work? Yes _____ No _____
If yes, what is the best time to call? ______________________________________________________________________________
What is your business telephone number? ________________________________________________________________________
PLEASE READ AND SIGN BELOW
The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on this
application may result in my dismissal. I further understand that this application is not and is not intended to be a contract of
employment, not does this application obligate the employer in any way if he decides to employ me. I understand and agree that my
employment is at-will and can be terminated by either party with or without notice, at any time, for any reason or no reason. No one
other than an officer of the company has any authority to enter into any agreement for employment for any specified period of time or
to make any agreement contrary to the foregoing and then only in a writing signed by an officer.
___________________________________________________
Signature of Applicant
FOR INTERVIEWER’S USE
INTERVIEWER
DATE
COMMENTS
FOR TEST ADMINISTRATOR’S USE
TESTS
ADMINISTERED
DATE
RAW
SCORE
RATING
COMMENTS AND INTERPRETATION
*POSITION
NUMBER
RESULTS OF REFERENCE CHECK
#1
#2
#3
#4
See Page 2
City of Manchester
Parks & Recreation
359 Old Meramec Station Road
Manchester, Missouri 63021
636-391-6326 • 636-391-0467 (fax)
parks@manchestermo.gov
CERTIFICATE OF APPLICANT
AUTHORIZATION FOR RELEASE OF INFORMATION
(Read carefully before signing)
I, (print full name) ________________________________, hereby certify that all statements
made on or in connection with this application are true and complete to the best of my
knowledge and belief. I understand and agree that any mis-statements or omission of material
facts will cause forfeiture on my part of all rights to employment with the City of Manchester,
Missouri.
I hereby authorize all law enforcement agencies, the Veterans Administration, U.S. Army, U.S.
Navy, U.S. Air Force, all military agencies, all federal, state, or local government agencies, state
and federal tax bureaus, credit bureaus, schools and universities, to furnish the holder of this
release with all and any available information regarding me in order that he may determine my
suitability for employment.
I authorize the holder of this release to make inquiry of my present and past employers
regarding my character, integrity, and reputation. I authorize the release of any and all
information regarding my employment, credit, or any other information, whether personal or
otherwise, that may or may not be in their records, and release said company or person from all
liability for any damage whatsoever that may issue from furnishing such information to the
holder of this release.
A photostatic copy of this authorization will be considered as effective and valid as the original.
_________________________________________________ _______________
Signature of Applicant Date
_________________________________________________ _______________
Signature of Witness Date
Drivers License #___________________________________
Social Security #___________________________________
Date of Birth _______________________________________
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CITY OF MANCHESTER APPLICATION FOR EMPLOYMENT (City of Manchester)

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Completed 20 February 2021

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