Fill - Free fillable City Of Galena Kansas Application 2 PDF form

City of Galena Employment Application Page 1

City of Galena, KS

Employment

Application

The City of Galena is an Equal Opportunity Employer

!!!!!! PLEASE READ !!!!!

IMPORTANT INSTRUCTIONS FOR COMPLETING AND

SUBMITTING THE EMPLOYEE APPLICATION FORM

Completed employment applications may be submitted for consideration in 1 of 3

ways:

1. PRINT: Completed employment applications may be printed and submitted to the

City of Galena at the following address:

Attn: Flora Charles, City Clerk

211 W. 7th Street

Galena, KS 66739

Police Department applicants may submit their completed applications to:

Attn: Billy J. Charles, Jr., Chief of Police

Galena Police Department

210 Turner Dr.

Galena, KS 66739

2. EMAIL: PDF applications that are filled out online may be saved and then

emailed as an attachement to:

f.charles@galenaks.gov (City Job Applicants)

or

b.charles@galenaks.gov (Police Department Applicants)

3. SUBMIT VIA PDF: The PDF Application Form contains a ‘SUBMIT’ button for

sending your completed application to us. Applications may only be submitted

this way from within Adobe Acrobat. (You can download the free Adobe Acrobat

reader



here



.)



If you completed your application using a web browser plugin or

extension, you will need to save your application to your harddrive, open it in

Adobe Acrobat, then press the ‘SUBMIT’ button. Doing so, will launch your

default email software and automatically attach your completed application.

Pressing SEND will email your application to us.

City of Galena Employment Application Page 2

Personal Information Date of Application Received:

Name: Date of Birth:

Social Security Number: Phone: ( )

Driver’s License: State: Number:

Address:

City: State: Zip:

E-Mail Address:

Employment Desired

Position Applied For:

Expected Pay: Applying For: Full Time: Part Time:

Have you ever been an employee of the City of Galena: Dates?

Date you would be available for work:

Referred by:

Special Training or Skills that would be of benefit in the job for which you are applying

Are you legally eligible for employment in the United States? Yes No

If you are a veteran, please list the branch(s) of service and dates served to include type of discharge

received.

Branch of Service Dates of Service Type of Discharge

CLEAR

SUBMIT

City of Galena Employment Application Page 3

Employment Experience:

Employer:

Address: City: State: Zip:

Phone: ( ) Supervisor:

Dates Employed: (MM/YY) (MM/YY)

Hourly Rate/Salary: Starting: Final:

Position Held:

Reason for Leaving:

Employer:

Address: City: State: Zip:

Phone: ( ) Supervisor:

Dates Employed: (MM/YY) (MM/YY)

Hourly Rate/Salary: Starting: Final:

Position Held:

Reason for Leaving:

Employer:

Address: City: State: Zip:

Phone: ( ) Supervisor:

Dates Employed: (MM/YY) (MM/YY)

Hourly Rate/Salary: Starting: Final:

Position Held:

Reason for Leaving:

City of Galena Employment Application Page 4

Employer:

Address: City: State: Zip:

Phone: ( ) Supervisor:

Dates Employed: (MM/YY) (MM/YY)

Hourly Rate/Salary: Starting: Final:

Position Held:

Reason for Leaving:

Educational Background

Grammar School:

Name of School: Location:

High School:

Name of School: Location:

Did you graduate: Diploma / GED: Month/Year:

College:

Name of School: Location

Course of Study: Did you graduate? Year:

Degree or Diploma:

Vocational Training - Other

Name of School: Location

Course of Study: Did you graduate? Year:

Continuing Education

City of Galena Employment Application Page 5

References:

Include supervisors and person we may contact to verify your performance and qualifications.

Do not give names of persons related to you.

Name: Your Supervisor?

Occupation: Organization:

Mailing Address: City: State: Zip:

Phone: ( )

Name: Your Supervisor?

Occupation: Organization:

Mailing Address: City: State: Zip:

Phone: ( )

Name: Your Supervisor?

Occupation: Organization:

Mailing Address: City: State: Zip:

Phone: ( )

I certify that all the information submitted by me on this application is true and complete, and I understand

that if any false or misleading information, omissions, or misrepresentations are discovered, my application

may be rejected, and if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the office’s rules and regulations, and I understand

that these rules and or the employee handbook do not form a contract of employment either expressed or

implied, and I agree that my employment and compensation can be terminated, with or without cause, and

with or without notice, at any time, at either my or the department’s option. I also understand and agree that

the terms and conditions of my employment may be changed, with or without cause and with or without

notice, at any time by the office. I understand that no city representative, other than the Mayor, and then only

when in writing and signed by the Mayor, has any authority to enter into an agreement for employment for

any specific period of time, or to make any agreement contrary to the foregoing.

Applicant Signature: Date:

click to sign

signature

click to edit

City of Galena Employment Application Page 6

Do Not Write Below this Line

(City of Galena Official Use Only)

Background and References Checked by: Date:

Interviewed By: Date:

Physical Fitness Test: Score: Date:

Written Test: Score: Date:

Physical Scheduled By: Date:

Location of Physical: Date:

Physiological Test By: Date:

Hired: Date:

Start Date: Department:

Position: Salary/Wage:

Department Head:

Remarks:

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