Fillable Cog Employment Application 2014.08.05 Fillable 1

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Cog Employment Application 2014.08.05 Fillable 1

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The Cog Employment Application 2014.08.05 Fillable 1 form is 7 pages long and contains:

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  • 19 check-boxes
  • 118 other fields

Country of origin: US
File type: PDF

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BROWSE CITY OF GUSTAVUS (AK) FORMS

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________________________________________________________________________________________________
City of Gustavus Employment Application
Page 1 of 7
City of Gustavus City of Gustavus
Employment Application PO Box 1
Adopted May 10, 2012 Gustavus, AK 99826
Tel. 907-697-2451
Fax. 907-697-2136
The City of Gustavus considers applicants for all positions without
regard to race, color, religion, creed, gender, national origin, age,
disability, marital or veteran status, sexual orientation, or any other
legally protected status. The City of Gustavus is a drug-free and smoke-
free workplace.
Note: Application must be completed. Resumes may not be substituted.
(Please Print)
Position(s) applied for:
Date of application:
Last Name First Name Middle Name
List any other names you may have used:
Physical Address (Number Street City State Zip)
Mailing Address
Telephone Numbers (landline, cellular, message)
Proof of citizenship or immigration status will be required upon
employment.
Question
Yes
No
proof of your eligibility to work?
If yes, date:
If yes, date:
If yes, State: License #
________________________________________________________________________________________________
City of Gustavus Employment Application
Page 2 of 7
Applicant Name____________________________________________
Question
Yes
No
May we contact your present employer?
Family member employed by the City of Gustavus? If so, give
name and relationship
Have you been convicted of a felony within the last 7 years?
(Conviction will not necessarily disqualify an applicant from
employment)
If yes, please explain:
Are you available to work (circle as applicable) :
Full-time Part-time Temporary
When would you be able to start work? ____________________
Employment or other job-related work experience:
Start with your present or last position. If you need additional space,
please continue on a separate sheet of paper. Job-related work
experience may include volunteer work, internships, etc.
Dates: From (mm/dd/yy) To (mm/dd/yy)
Name of firm/agency:
Address:
Phone: E-mail:
Position Title: Supervisor:
Final hourly rate/salary______________
Duties:
Reason for leaving:
________________________________________________________________________________________________
City of Gustavus Employment Application
Page 3 of 7
Applicant Name____________________________________________
Dates: From (mm/dd/yy) To (mm/dd/yy)
Name of firm/agency:
Address:
Phone: E-mail:
Position Title: Supervisor:
Final hourly rate/salary______________
Duties:
Reason for leaving:
Dates: From (mm/dd/yy) To (mm/dd/yy)
Name of firm/agency:
Address:
Phone: E-mail:
Position Title: Supervisor:
Final hourly rate/salary______________
Duties:
Reason for leaving:
________________________________________________________________________________________________
City of Gustavus Employment Application
Page 4 of 7
Applicant Name____________________________________________
Dates: From (mm/dd/yy) To (mm/dd/yy)
Name of firm/agency:
Address:
Phone: E-mail:
Position Title: Supervisor:
Final hourly rate/salary______________
Duties:
Reason for leaving:
Dates: From (mm/dd/yy) To (mm/dd/yy)
Name of firm/agency:
Address:
Phone: E-mail:
Position Title: Supervisor:
Final hourly rate/salary______________
Duties:
Reason for leaving:
________________________________________________________________________________________________
City of Gustavus Employment Application
Page 5 of 7
Applicant Name____________________________________________
Dates: From (mm/dd/yy) To (mm/dd/yy)
Name of firm/agency:
Address:
Phone: E-mail:
Position Title: Supervisor:
Final hourly rate/salary______________
Duties:
Reason for leaving:
Dates: From (mm/dd/yy) To (mm/dd/yy)
Name of firm/agency:
Address:
Phone: E-mail:
Position Title: Supervisor:
Final hourly rate/salary______________
Duties:
Reason for leaving:
________________________________________________________________________________________________
City of Gustavus Employment Application
Page 6 of 7
Applicant Name____________________________________________
Additional References
(Please do not list past employers mentioned above or family members.)
1. (Name, phone, mailing address)
2. (Name, phone, mailing address)
3. (Name, phone, mailing address)
Applicant acknowledges and agrees that the City of Gustavus may
contact any or all of the individuals identified above, as well as any
or all of the Applicant’s previous employers identified herein, to
discuss matters pertaining to this application.
Education
Level
Name, Location
Course of
Study/
Training
Dates of
Enrollment
(Month/Year)
Diploma/
Degree
(Date)
College
Business,
Trade, or
Technical
High
School
Specialized Skills
Describe any specialized training, skills, professional certifications,
licenses, or qualifications:
________________________________________________________________________________________________
City of Gustavus Employment Application
Page 7 of 7
Applicant Name____________________________________________
Certification Statement
To be considered for employment, an applicant must include a signed
and dated certification that states as follows:
I certify that the information I have entered on this form is true and
complete to the best of my knowledge. I have read and understand the
position description for this job, a copy of which is attached to and made
a part of this application. I believe that I am qualified to assume and
perform the duties and responsibilities of this position. I understand that
if I deliberately conceal or enter false information on this form, that I may
be removed from my job; that nothing contained in this employment
application or in the granting of an interview is intended to create a
contract between me and the City of Gustavus for either employment or
the provision of any benefits; that information in this application will
become part of the public record; and that for the purpose of this
certification, a photocopy of my original signature shall have the same
force and effect as my original signature. I hereby authorize the City of
Gustavus, or its agents, to contact the references I provided as part of
this application in order to obtain additional information relevant to my
position- related background, education, skills and abilities. I
understand that, prior to making any offer of Page 7 of 7employment; the
City of Gustavus may request my authorization to conduct a confidential
background check to obtain additional information relevant to this
employment application.
____________________________________ ________________________
Signature of Applicant Date
For City of Gustavus Use Only
Arranged interview: Yes____ No____
Remarks:
Interviewer ____________________ Date____________________
Employed: Yes____ No____ Date of Employment _________________
Position Title
Hourly Rate/Salary Department
By
If applicant is hired, this application will be placed in the personnel file.
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Cog Employment Application 2014.08.05 Fillable 1

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Completed 12 July 2020

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