Fillable Employment Application (City and Borough of Wrangell, Alaska)

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Employment Application (City and Borough of Wrangell, Alaska)

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The Employment Application (City and Borough of Wrangell, Alaska) form is 6 pages long and contains:

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  • 14 check-boxes
  • 167 other fields

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CITY AND BOROUGH OF WRANGELL
PO Box 531 Wrangell, AK 99929
Phone (907) 874-2381 Fax (907) 874-3952
Email jmason@wrangell.com
Employment Application
The City & Borough of Wrangell is an Equal Opportunity Employer and Provider.
A Pre-Employment Drug Screen and Criminal Background Check is Required.
Applicant Name Date
Mailing Address
Home phone Mobile phone
Email_____________________
Position applying for
Are you at least 18 years of age? ☐ Yes ☐ No
If required by the position, do you have a valid Alaska driver’s license? ☐ Yes ☐ No
Are you a US Citizen or do you have authorization to work in the US? ☐ Yes ☐ No
Are you currently employed? ☐ Yes ☐ No May we contact your current employer? ☐ Yes ☐ No
Have you worked for the City & Borough of Wrangell before? ☐ Yes ☐ No
If yes, provide the dates, positions, and departments __________________________________________________
______________________________________________________________________________________________
How did you find out about this position? ☐ Borough Website ☐ Word of Mouth ☐ Newspaper/Radio
☐ Borough Social Media ☐ Other Please specify _____________________________________________
Are you related to any Borough Assembly Member, the Mayor, or Borough Manager? ☐ Yes ☐ No
(this will not prevent employment with the City & Borough of Wrangell) If Yes, provide the name and relationship
to this person __________________________________________________________________________________
Are you related to anyone currently employed by the City & Borough of Wrangell? ☐ Yes ☐ No
(this will not prevent employment with the City & Borough of Wrangell) If Yes, provide the name and relationship
to this person __________________________________________________________________________________
Please provide the names of three professional references, whom you have known for at least one year
Name
Phone
Relationship
Years acquainted
Educational Background (include all that apply)
School name & location
Major/degree/certification
Year Completed
High school
Trade school
College
College
College
Other
Licensure, registration, certification, other special training
Year
Expired/expires
Please describe what experience and skills you have obtained that qualify you for the desired position
(Note If provided in detail in an enclosed letter of interest, you may leave this section blank)
Employment History
( If this is provided in complete detail in an enclosed résumé or C.V., you may leave this section blank)
Are you currently employed? ☐ Yes ☐ No May we contact your current employer? ☐ Yes ☐ No
May we contact your previous employers? ☐ Yes ☐ No
Instructions - Begin with your current or most recent job. Include military service (indicate rank) and bona fide
volunteer work. List each promotion or transfer as a separate job, even if with the same employer. All
information in this section must be completed unless provided in complete detail on an enclosed résumé or C.V.
Prior employers and supervisors may be contacted regarding your work experience. Please submit at least ten
years of employment experience. If more space is needed, attach additional pages.
Employer
Supervisor name, title
Your position
title
Start and end dates
Describe duties
Ending pay
Reason for leaving
Employer
Supervisor name, title
Your position
title
Start and end dates
Describe duties
Ending pay
Reason for leaving
Employer
Supervisor name, title
Your
position title
Start and end dates
Describe duties
Ending pay
Reason for leaving
Employer
Supervisor name, title
Your position
title
Start and end dates
Describe duties
Ending pay
Reason for leaving
Employer
Supervisor name, title
Your position
title
Start and end dates
Describe duties
Ending pay
Reason for leaving
Employer
Supervisor name, title
Your position
title
Start and end dates
Describe duties
Ending pay
Reason for leaving
Please explain any gaps in employment (optional)
Address History
Please submit at least ten years of history. If more space is needed, attach additional pages.
Current Address
Street Address
City, State
Zip Code
Length of Time at Address
Previous Addresses
Street Address
City, State
Zip Code
Length of Time at Address
Street Address
City, State
Zip Code
Length of Time at Address
Street Address
City, State
Zip Code
Length of Time at Address
Street Address
City, State
Zip Code
Length of Time at Address
Street Address
City, State
Zip Code
Length of Time at Address
Street Address
City, State
Zip Code
Length of Time at Address
Street Address
City, State
Zip Code
Length of Time at Address
Criminal History
The following information does not in itself disqualify applicants from employment, but
must be answered truthfully.
This information will be reviewed by the Human Resources Department.
Have you ever been convicted of, pled guilty or no contest to, or had a suspended imposition of
sentence to a criminal offense, including, but not limited to, a felony, misdemeanor, violation, or
infraction under federal, state, or local law? ☐ Yes ☐ No
If yes, please provide dates and describe in full:
I certify that all the information submitted by me on this application and any attachments is true and complete to
the best of my knowledge, and that I have not knowingly withheld any facts or circumstances. I understand that if
any false information, omissions, or misrepresentations are discovered at any time, my application may be rejected
and may be grounds for removal from eligibility, or discharge from employment. I understand that all job offers will
be contingent upon a satisfactory background check and successful completion of a pre-employment drug screening
and I authorize the City & Borough of Wrangell to conduct such. I further authorize the City and Borough of Wrangell
to contact my references and any other persons/sources to verify the information on this application. If applicable
to the position, I authorize the City & Borough of Wrangell to verify my driving record.
Signature: Date:
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City and Borough of Wrangell
Equal Employment Opportunity
Self Identification Survey
Last Name
First & Middle Name
Date of Application
Position Applied For
Veteran Status
Yes, I am a veteran
No, I am not a veteran
To All Applicants
The information requested on this page is voluntary and is used by the City and Borough of Wrangell to comply with the
regulations of the Equal Employment Commission and the Alaska State Commission for Human Rights. This information
will not be seen by the hiring board for any jobs that you are applying for or by any employee of the City & Borough of
Wrangell, other than the HR Department. It will be kept confidential and be available only to Federal and State personnel
legally charged with administering Civil Rights Laws and Regulations. However, statistical information compiled from
records on age, gender, and race shall be made available to the public.
RACE, ETHNICITY AND GENDER INFORMATION
African American ☐
Alaskan Native/American Indian ☐
Asian or Pacific Islander ☐
Caucasian ☐
Hispanic ☐
Two or more Races ☐
I do not wish to identify ☐
Gender: ☐ Female ☐ Male ☐ I do not wish to identify
Definitions of Racial/Ethnic Groups
The racial/ethnic groups for Federal and State reporting purposes are defined as follows:
African American~ A person having origins in any of the black racial groups of Africa (not of Hispanic origin).
Alaskan Native~ A person having origins in any of the original peoples of Alaska and who maintains cultural identification
through tribal affiliation or community recognition. Alaskan Native may include, for example, any person of Yup'ik,
Inupiat, Aleut, Athabascan, Tlingit, Haida or Tsimshian origin.
American Indian~ A person having origins in any of the original peoples of North America (not including Alaska)
and who maintains cultural identification through tribal affiliation or community recognition.
Asian or Pacific Islander~ A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian
Subcontinent or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and
Samoa.
Caucasian~ A person having origins on any of the original people of Europe, North Africa or the Middle East (not of
Hispanic origin).
Hispanic~ A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin,
regardless of race.
Two or more races~ A person whose parents or ancestors are from two or more ethnic backgrounds described in
this section.
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Employment Application (City and Borough of Wrangell, Alaska)

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Completed 2 July 2021

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