City of Hudson Application for Employment - Page 1
CITY OF HUDSON, WISCONSIN
APPLICATION FOR EMPLOYMENT
City of Hudson
505 Third Street, Hudson, WI 54016
(PLEASE PRINT OR TYPE)
Position Being Applied For
Last Name
First Name
Middle Name
Street Address
City, State, Zip
City, State, Zip
Phone Number
Education
Do you have a high school diploma or GED equivalent? (yes or no)
Post high school education (university, technical college, certificate programs, etc.)
Dates Attended
Did you
graduate?
(yes or no)
List Degree Type (Certificate,
Associates, Bachelors, Masters, etc.)
and Course of Study
From
To
List certifications or licenses that are relevant to, or required for, this position
Type of Certification
or License
Certificate or License Number
(if any)
Expiration Date (if any)
Employment Experience
On the next two pages, provide your most recent employment history, starting with your
current or most recent job. If you received promotions with the same employer, note this in
the section where you list your duties and responsibilities. Provide all information in each
section. If you had breaks in your employment or have additional employment experience that
you feel is relevant to this position, please attach details on a separate page.
City of Hudson Application for Employment - Page 2
Employer
City, State
Position
Supervisor
Start Date
End Date
Last Wage
or Salary
Number of Staff
Supervised
Hours Worked
Per Week
Reason for
Leaving
May we contact this employer? If yes, please
provide a contact person and phone number
Detail major duties and responsibilities, especially those relevant to position being applied for
Employer
City, State
Position
Supervisor
Start Date
End Date
Last Wage
or Salary
Number of Staff
Supervised
Hours Worked
Per Week
Reason for
Leaving
May we contact this employer? If yes, please
provide a contact person and phone number
Detail major duties and responsibilities, especially those relevant to position being applied for
City of Hudson Application for Employment - Page 3
Employer
City, State
Position
Supervisor
Start Date
End Date
Last Wage
or Salary
Number of Staff
Supervised
Hours Worked
Per Week
Reason for
Leaving
May we contact this employer? If yes, please
provide a contact person and phone number
Detail major duties and responsibilities, especially those relevant to position being applied for
Employer
City, State
Position
Supervisor
Start Date
End Date
Last Wage
or Salary
Number of Staff
Supervised
Hours Worked
Per Week
Reason for
Leaving
May we contact this employer? If yes, please
provide a contact person and phone number
Detail major duties and responsibilities, especially those relevant to position being applied for
City of Hudson Application for Employment - Page 4
If selected for the position, when would you be available for employment?
If you have ever served in the United States military, please provide details below
Branch of Military Service
Serial Number
Dates of Service
From
To
List any professional or civic organizations or volunteer activities that you have participated
in relevant to this position, including any leadership positions you may have held
List any machinery, software, tools or other equipment or devices that you have
utilized in your prior employment that would be relevant to this position
Applicant’s Statement
I certify that the information provided on this application is true and complete to the
best of my knowledge. In the event of employment, I understand that any false or
misleading information given in my application or in any interview(s) or testing may
result in my immediate discharge.
I authorize the verification of all information and statements contained in this
application for employment as may be necessary in arriving at an employment
decision. I understand that if I am offered employment, I may be subject to a criminal
background check to determine fitness for the position.
I understand that this application does not constitute an offer of employment with the
City of Hudson. I understand that it is my responsibility to submit any contact
information or availability changes to the City’s Human Resources Director.
________________ __________________________________________________
Applicant Signature Date Signed
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