Fillable City Of Evans Application.2014 Fillable 0 - Employment Application 01.2012.revised

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City Of Evans Application.2014 Fillable 0 - Employment Application 01.2012.revised

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1/2012
CITY OF EVANS APPLICATION FOR EMPLOYMENT
H
uman Resources
1100 37
th
Street
Evans, CO 80620
www.evanscolorado.
gov
Human Resources
Phone: (970) 475-1161
Fax: (970) 330-3472
An Equal Opportunity Employer
We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation.
It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.
PERSONAL DATA
Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Use
blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on back of application. In
reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or
discrimination based upon non-job-related information.
Job Applied for: Date:
Are you
seeking: Full-time
Part-time Temporary employment? When could you start work?___________________
Last Name: First Name: Middle Name: E-Mail Address:
Hom
e Phone Cell Phone: Business Phone:
Prese
nt Street Address:
City: State: Zip
Code:
Are
you 18 years of age or older? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
No
(If you are hired, you may be required to submit proof of age)
Social Security # (optional)_______________ If hired, can you furnish proof you are eligible to work in the U.S.? Yes No
Have
you ever applied here before? Yes
No If yes, when? ______________________________________
Were you ever employed here? Yes
No If yes, when? ______________________________________
Have you ever been convicted of any law violation? Include any
plea of “guilty” or “no contest.” (exclude minor traffic violations) . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
No
If yes, give details:_______________________________________________________________________________________
(a conviction will not necessarily disqualify an applicant for employment)
If employed, do you expect to be engaged in any additional business
or employment outside of our job? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
No
If yes, give details: ______________________________________________________________________________________
Do you have a valid driver’s license? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
No
Driver’s License Number ____________________ Class of License ___________________ State Licensed In __________
Have you had your driver’s license suspended or revoked in the last 3 years? . . . . . . . . . . . . . . . . . . . . . Yes
No
If yes, give details: _______________________________________________________________________________________
List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race,
color, religion, national origin, sex, age, disability or other protected status)______________________________________________
1/2012
WORK HISTORY
List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and
any periods of unemployment. If self-employed, give name and supply business references. Note: A job offer may be contingent upon acceptable
references from current and former employers.
Name of Employer Job Title
Address Dates of Employment (MO/YR)
From: To:
City, State, Zip Code Pay:
Start $ Final $
Supervisor(s)
Telephone Reason for Leaving
Duties:
* If currently employed, may we contact your employer Yes No
Name of Employer Job Title
Address Dates of Employment (MO/YR)
From: To:
City, State, Zip Code Pay:
Start $ Final $
Supervisor(s)
Telephone Reason for Leaving
Duties:
Name of Employer Job Title
Address Dates of Employment (MO/YR)
From: To:
City, State, Zip Code Pay:
Start $ Final $
Supervisor(s)
Telephone Reason for Leaving
Duties:
1/2012
PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING
I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may
disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.
I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current
employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release
such persons and organizations from any legal liability in making such statements.
I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre –and/or post-employment drug screen as
a condition of employment, if required.
I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical
examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which
I am applying.
I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES
NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE
PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY
EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.
I have read, understand and by my signature consent to these statements.
Signature______________________________________ Print__________________________________ Date _________________
EDUCATION AND TRAINING
High School or GED: Yes
No
Name/Location of High School:__________________________________________________
1. College/University & location__________________________________________________ Did you graduate? Yes No
If yes, Major and type of Degree earned____________________________________________
2. College/University & location___________________________________________________ Did you graduate? Yes
No
If yes, Major and type of Degree earned_____________________________________________
Vocational or Technical: _____________________________________________________________________________________
Have you worked or attended school under any other names? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
No
If yes, give names: __________________________________________________________________________________________
What skills or additional training do you have that relate to the job for which you are applying?
________________________________________________________________________________________________________
What machines or equipment can you operate that relate to the job for which are you applying?
__________________________________________________________________________________________________________
REFERENCES
Give three references, not relatives or former employers, having knowledge of your character, experience or ability.
Name:
Address: Phone Number: Relationship:
Name:
Address: Phone Number: Relationship:
Name:
Address: Phone Number: Relationship:
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Completed 12 July 2020

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