Fillable Employment Application - Town Of Buena Vista

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Employment Application - Town Of Buena Vista

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Country of origin: US
File type: PDF

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1
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age,
disability, marital or veteran status, or any other legally protected status.
(PLEASE PRINT)
Position Applied for Date of Application
How Did You Learn About Us?
Friend/
Advertisement
Employment
Agency
Relative
Inquiry
Other
_____________________
Last Name First Name Middle Initial
Address
Number Street City State Zip Code
Telephone Number(s)
Home Cell
Social Security Number
Email:
Best time to contact you at home is: ___________________
If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No
Yes No
Yes No
Have you ever filed an application with us before?
If Yes, give date ______________________________
Have you ever been employed with us before?
If Yes, give date ______________________________
No
Do any of your friends or relatives, other than spouse, work here?
If Yes, state name, relationship and location
____________________________________________
Yes No Are you currently employed?
May we contact your present employer? Yes No
Yes No Are you prevented from lawfully becoming employed in this country because of
Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.
town of buena vista
Post Office Box 2002
Buena Vista, Colorado 81211 Phone:
(719) 395-8643
Fax: (719) 395-8644
employment application
Yes
Date available for work _______/_______/_______ What is your desired salary range? ___________________
Are you available to work: Full Time (Please indicate 1 2 3 shift) ____________________
Part Time (Please indicate Morning Afternoon Evenings) ______________
Temporary (Please indicate dates available_______________)
Yes No Are you currently on “lay-off” status and subject to recall?
Can you travel if a job requires it? Yes No
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
EDUCATION
School Name and address of school Course of Study Years Completed Diploma/Degree
Undergraduate
College
Graduate/
Professional
(Specify)
WORK EXPERIENCE
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may
exclude organizations which indicate race, color; religion, gender, national origin, disabilities or other protected status.
Employer
Dates Employed Work Performed
From To
Address
Telephone Number(s)
Starting/Present Job Title
Hourly Rate/Salary
Supervisor
Starting Final
Reason for Leaving May We Contact? Yes No
Employer Dates Employed Work Performed
From To
Address
Telephone Number(s)
Starting/Present Job Title
Hourly Rate/Salary
Supervisor
Starting Final
Reason for Leaving May We Contact? Yes No
Employer Dates Employed Work Performed
From To
Address
Telephone Number(s)
Starting/Present Job Title
Hourly Rate/Salary
Supervisor
Starting Final
Reason for Leaving May We Contact? Yes No
2
High School
Other
Employer Dates Employed Work Performed
From To
Address
Telephone Number(s)
Starting/Present Job Title
Hourly Rate/Salary
Supervisor
Starting Final
Reason for Leaving May We Contact? Yes No
Comments: Include explanation of any gaps in employment:
Describe any specialized training, apprenticeship, skills, and extra-curricular activities.
Describe any job-related training received in the United States military.
List professional, trade business, or civic activities and offices held.
You may exclude membership which would reveal gender, race, religious, national origin, age, ancestry, disability or other
protected status:
ADDITIONAL INFORMATION
Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience.
SPECIALIZED SKILLS (Skills/Equipment Operated)
Production/Mobile
_____Terminal
_____PC/MAC
_____Typewriter
WPM_____
_____Spreadsheet
_____Word Processing
_____Shorthand
WPM_____
Machinery (list)
____________________
____________________
____________________
Other (list)
_______________________
_______________________
________________________
State any additional information you feel may be helpful to us in considering your application.
______________________________________________________________________________________________________________________________
________________________________________________________________________________________________________
______
________________________________________________________________________________________________________
________________________________________________________________________________________________________
3
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS
OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the
activities involved in the job or occupation for which you have applied? A review of the activities involved in such
a job or occupation has been given. Yes No
PERSONAL/PROFESSIONAL REFERENCES Do not include family members or past supervisors.
Name Phone Number Best Time to Call
Occupation
1.
2.
3.
APPLICANT’S STATEMENT
I certify that answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an
employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to
be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at
that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this
organization is of an “at will” nature, which means that the employee may resign at any time and the Employer may discharge
Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be
changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized
executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result
in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Signature: ____________________________________ Date: ________________
Revised 11/8/17
4
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Employment Application - Town Of Buena Vista

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Completed 16 July 2020

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