Fill - Free fillable City of Arkadelphia Application for Employment (City of Arkadelphia) PDF form

City of Arkadelphia Application for Employment

Name:

___________________________ ___________________________ ______________________

Last

First

Middle

Mailing Address:

__________________________ _______________________ _________ _________

Street

City

State

Zip

E-Mail Address: ________________________________________________________________________________________

Telephone number:

___________________________________________________________________

Position Applying for:

__________________________________________________________________

Can you perform the duties (essential function of the job), with or without a reasonable accommodation?

Yes No

Minimum salary requirement:

___________________________________________________________

Employment History: List all employment (including military service) for at least the past five years.

Begin with your current employer and complete from most recent to previous. Attach additional

sheets if more space is needed.

Current Employer:

May we contact this employer? Yes No

Company:

_________________________________

Job Title:

___________________________________

Address:

___________________________________________________

Telephone:

________________

Supervisor:

_______________

Salary:

_______

Employment Dates: from

___________

to _

___________

Reason for Leaving:

____________________________________________________________________

List job duties:

________________________________________________________________________

____________________________________________________________________________________

Previous Employers:

Company:

_________________________________

Job Title:

__________________________________

Address:

___________________________________________________

Telephone:

_________________

Supervisor:

_______________

Salary:

_______

Employment Dates: from

__________

to

_____________

Reason for Leaving:

____________________________________________________________________

List job duties:

________________________________________________________________________

____________________________________________________________________________________

City of Arkadelphia Application for Employment

Company:

_________________________________

Job Title:

__________________________________

Address:

__________________________________________________

Telephone:

_________________

Supervisor:

_______________

Salary:

_______

Employment Dates: from

___________

to

____________

Reason for Leaving: ___________________________________________________________________

List job duties:

________________________________________________________________________

____________________________________________________________________________________

Company:

_________________________________

Job Title:

__________________________________

Address:

___________________________________________________

Telephone:

________________

Supervisor:

_______________

Salary:

_______

Employment Dates: from

__________

to

_____________

Reason for Leaving:

____________________________________________________________________

List job duties:

________________________________________________________________________

____________________________________________________________________________________

Education

High School Graduate: Yes No If not, have you recieved a GED: Yes No

Highest grade completed: (12=HS grad, 16=BA/BS degree, 18=MS/MA)

_________

List all college, business, or trade school courses or degrees completed:

School Name

Subject/Degree Completed

Dates

Attach additional sheets if more space is needed

List all licenses/certifications you hold (drivers, water/wastewater, CDL, plumbing insp., electrician,

lifeguard, etc.)

_________________________________________________________________________

____________________________________________________________________________________

City of Arkadelphia Application for Employment

List equipment, office machines, and computer programs you have experience operating:

____________________________________________________________________________________

Please list any additional experience, skills, or training you have had which would help you

qualify for the position you are seeking:

____________________________________________________

____________________________________________________________________________________

Other Information

Are you related to any current City employees or any member of the Board of Directors? Yes No

If yes, please give name and relationship:

__________________________________________________

References:

Give the names and address of three (3) persons (not relatives) who have knowledge of your experience,

abilities, and knowledge.

Name

Address

Phone Number

Have you ever been convicted of a violation of the law (other than minor traffic violations)? Yes No

If yes, list details to include dates and violation history:

________________________________________

(Convictions do not automatically disqualify you from employment)

Please list any languages you speak, other than English:

_______________________________________

City of Arkadelphia Application for Employment

CERTIFICATION:

I hereby certify that all information I have supplied is true and factual. I agree and understand that

any false, misleading, or incomplete information, regardless of time of discovery, may cause my

dismissal of employment or rejection as an applicant.

I am eligible for employment (per the Immigration and Reform Control Act of 1986) in the United

States and will provide proper documentation should I be hired.

I understand certain jobs may require an acceptable driver's safety record, and that if my current or

future driver's record is unacceptable, my application may be rejected, and if hired, I may be subject

to termination.

Certain jobs may require a physical and /or psychological exam. I understand these selected job

offers will be conditional upon passing the required examination.

I give permission for you to check the references I have provided and for the persons contacted to

answer your questions about me. I also understand previous employers will be contacted and I will

sign a consent for employment records release.

I understand that this application does not create any contractual or other legal rights. It does not

alter the at-will employment status nor does it create an employment contract for any specified

period of time.

Signature of Applicant:

___________________________________________

Date:

_________________

All job offers are subject to approval by the City Manager. This application is the property of the City of

Arkadelphia and will become part of the applicant's personnel file if accepted for employment.

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Fill Online, Printable, Fillable, Blank City of Arkadelphia Application for Employment (City of Arkadelphia) Form

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Fillable City of Arkadelphia Application for Employment (City of Arkadelphia)

Fill Online, Printable, Fillable, Blank City of Arkadelphia Application for Employment (City of Arkadelphia) Form

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