Fillable EMPLOYMENT APPLICATION

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EMPLOYMENT APPLICATION

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EMPLOYMENT APPLICATION
Return To:
Human Resources
214 W. 15
th
Street
Cheyenne, WY 82002
Telephone: 307-777-2823
EQUAL ACCESS TO PROGRAMS, SERVICES AND EMPLOYMENT IS AVAILABLE TO ALL PERSONS. THOSE
APPLICANTS REQUIRING REASONABLE ACCOMMODATION TO THE APPLICATION AND/OR INTERVIEW
PROCESS SHOULD NOTIFY THE HUMAN RESOURCES DEPARTMENT.
LAST NAME
FIRST NAME
MIDDLE INITIAL
MAILING ADDRESS
CITY
STATE
ZIP
HOME PHONE
COLLEGE OR VOCATIONAL SCHOOL AND LOCATION
MAJOR
MINOR
DEGREE
EARNED
List your employers (minimum of last 5 years). Please Note: your application will not be considered
unless every question in this section is answered. Since we will make every effort to contact previous
employers, the correct telephone numbers of past employers is critical. Even if you have a resume,
you must complete this section and also attach resume.
1. EMPLOYER:
ADDRESS:
FROM: MO/YR
TO: MO/YR
HOURS PER WEEK:
YOUR TITLE:
SUPERVISOR:
TELEPHONE:
FAX:
NO. & TYPE OF EMPLOYEES YOU SUPERVISED:
DUTIES:
REASON FOR LEAVING:
MAY WE CONTACT FOR REFERENCE?
2. EMPLOYER:
ADDRESS:
FROM: MO/YR
TO: MO/YR
HOURS PER WEEK:
YOUR TITLE:
SUPERVISOR:
TELEPHONE:
FAX:
NO. & TYPE OF EMPLOYEES YOU SUPERVISED:
DUTIES:
REASON FOR LEAVING:
MAY WE CONTACT FOR REFERENCE?
3. EMPLOYER:
ADDRESS:
FROM: MO/YR
TO: MO/YR
HOURS PER WEEK:
YOUR TITLE:
SUPERVISOR:
TELEPHONE:
FAX:
NO. & TYPE OF EMPLOYEES YOU SUPERVISED:
DUTIES:
REASON FOR LEAVING:
MAY WE CONTACT FOR REFERENCE?
4. EMPLOYER:
ADDRESS:
FROM: MO/YR
TO: MO/YR
HOURS PER WEEK:
YOUR TITLE:
SUPERVISOR:
TELEPHONE:
FAX:
NO. & TYPE OF EMPLOYEES YOU SUPERVISED:
DUTIES:
REASON FOR LEAVING:
MAY WE CONTACT FOR REFERENCE?
5. EMPLOYER:
ADDRESS:
FROM: MO/YR
TO: MO/YR
HOURS PER WEEK:
YOUR TITLE:
SUPERVISOR:
TELEPHONE:
FAX:
NO. & TYPE OF EMPLOYEES YOU SUPERVISED:
DUTIES:
REASON FOR LEAVING:
MAY WE CONTACT FOR REFERENCE?
6. EMPLOYER:
ADDRESS:
FROM: MO/YR
TO: MO/YR
HOURS PER WEEK:
YOUR TITLE:
SUPERVISOR:
TELEPHONE:
FAX:
NO. & TYPE OF EMPLOYEES YOU SUPERVISED:
DUTIES:
REASON FOR LEAVING:
MAY WE CONTACT FOR REFERENCE?
Salary you would consider appropriate for job ____________________________________________
List four (4) references with address, phone numbers and relationship.
1. _______________________________________________ 2. ________________________________________
_________________________________________________ __________________________________________
_________________________________________________ __________________________________________
_________________________________________________ __________________________________________
3. _______________________________________________ 4. ________________________________________
_________________________________________________ __________________________________________
_________________________________________________ __________________________________________
_________________________________________________ __________________________________________
AVAILABILITY:
WHAT DATE CAN YOU START?
CHECK TYPE OF EMPLOYMENT YOU WOULD ACCEPT:
FULL TIME PART TIME HRS/WK TEMPORARY
Applicant Statement
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect,
will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the
employer’s service whenever it is discovered.
I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain
information from all references (personal and professional), employers, public agencies, licensing authorities and
educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume
or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees
or representatives for seeking, gathering and using such information in the employment process and all other persons,
corporations or organizations for furnishing such information about me.
I understand that the employer does not unlawfully discriminate in employment and no question on this application is used
for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by
applicable local, state or federal law.
If I am hired, I understand that I am free to resign at any time with or without cause and without prior notice, and the
employer reserves the same right to terminate my employment at any time with or without cause and without prior notice,
except as may be required by law. This application does not constitute an agreement or contract for employment for any
specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to
make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express
language are valid unless they are in writing and signed by the employer’s CEO.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United
States and that federal immigration laws require me to complete and I-9 Form in this regard.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
I certify that I have read, fully understood and accept all terms of the foregoing Applicant Statement
Signature of Applicant Date
The Wyoming Business Council is an Equal Opportunity employer, committed to providing a work environment and
employment opportunities free from discrimination of any kind. Hiring, promotion, training, personnel and all other policies
were created in accordance with individual job-related qualifications and without regard to race, color, sex age, national
origin, religion or physical handicap.
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EMPLOYMENT APPLICATION

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Completed 19 April 2022

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