EMPLOYMENT APPLICATION
PLEASE PRINT CLEARLY IN INK OR TYPE
Education
High School, College, University, Technical or Trade School
School Name
Location: City / State
Course of Study
Years completed
Diploma / Degree
High School Graduate?
Y
N
GED? Y N
Are you 18 years of age or older?
Yes No If no, what is your date of birth? ______________________
Do you have the legal right to work in the United States?
Yes No
The City of Bisbee is an equal opportunity employer. We consider applicants for all positions without regard to age, color, creed,
disability, gender, national origin, marital status, race, religion, genetics or any other legally protected status.
Instructions: You may apply by mailing or delivering a completed application form to the City of Bisbee Personnel Department,
118 Arizona Street, Bisbee, AZ 85603. Applications can also be forwarded to personnel@BisbeeAz.gov or faxed to Personnel at
520-432-6069. Faxed or electronic applications must be followed by original hard copies. Resumes will not be accepted in
lieu of a completed application. Applications must be received in this office no later than 5 p.m. on the closing date of the
position in order to be considered. The applicant must clearly demonstrate on the application form that they meet the minimum
qualifications for the position. Complete each item accurately and specifically. A separate City of Bisbee application is required for
each position. Employment history continuation sheets should be used if additional space is required. Applications which are
incomplete, unsigned or applications with photocopied signatures, will not be accepted. The City of Bisbee only accepts
applications for posted positions. In compliance with the Immigration Reform & Control Act of 1986, individuals hired by the City
of Bisbee must submit proof of work eligibility. The City of Bisbee participates in the E-Verify Employment Verification Program.
Last Name First Name Middle Initial
Mailing Address Number Street City State Zip Code
Telephone Number(s) Email Social Security Number (voluntary)
___________________________________________________________________________________________________________
How did you learn about us?
City website City Employee Bisbee Observer SV Herald/Bisbee Daily Review Posted Job Announcement
1. Employer: Job Title:
_____________________________
Employer Address: _________________________________________________________________________________________
Telephone: ( ) If you are a finalist for this position may we contact?
Yes No
From: / to / Total months: Hours/ week: Salary: ___________________________
month year month year
Reason for Leaving: Name of Supervisor:
_______________________
Description of Duties: __________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____
________________________________________________________________________________________________________
Was this a supervisory or managerial position?
Yes No If Yes, please answer following questions:
Supervisory: How many employees did you directly supervise? ___________
Managerial: How many employees did you directly supervise? ___________
Total number of employees managed (directly and through subordinate supervisors): _________
2. Employer: Job Title:
_____________________________
Employer Address: _________________________________________________________________________________________
Telephone: ( ) If you are a finalist for this position may we contact?
Yes No
From: / to / Total months: Hours/ week: Salary: ___________________________
month year month year
Reason for Leaving: Name of Supervisor:
_______________________
Description of Duties: __________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____
________________________________________________________________________________________________________
Was this a supervisory or managerial position?
Yes No If Yes, please answer following questions:
Supervisory: How many employees did you directly supervise? ___________
Managerial: How many employees did you directly supervise? ___________
Total number of employees managed (directly and through subordinate supervisors): _________
EMPLOYMENT HISTORY: Please provide an accurate and complete description of any work which qualifies you for the job
for which you are applying. Include service in the armed forces or self-employment. This section must be completed in detail.
Start with your present or most recent employer. If you have more jobs to list than space allows, continue on the Employment
History Continuation Sheet. Applications that do not provide information showing that the applicant meets the required
minimum qualifications or knowledge, skills and abilities for the position will be rejected. Do not refer to a resume.
3. Employer: Job Title:
_____________________________
Employer Address: _________________________________________________________________________________________
Telephone: ( ) If you are a finalist for this position may we contact?
Yes No
From: / to / Total months: Hours/ week: Salary: ___________________________
month year month year
Reason for Leaving: Name of Supervisor:
_______________________
Description of Duties: __________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____
________________________________________________________________________________________________________
Was this a supervisory or managerial position?
Yes No If Yes, please answer following questions:
Supervisory: How many employees did you directly supervise? ___________
Managerial: How many employees did you directly supervise? ___________
Total number of employees managed (directly and through subordinate supervisors): _________
4. Employer: Job Title: _____________________________
Employer Address: _________________________________________________________________________________________
Telephone: ( ) If you are a finalist for this position may we contact?
Yes No
From: / to / Total months: Hours/ week: Salary: ___________________________
month year month year
Reason for Leaving: Name of Supervisor:
_______________________
Description of Duties: __________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____
________________________________________________________________________________________________________
Was this a supervisory or managerial position?
Yes No If Yes, please answer following questions:
Supervisory: How many employees did you directly supervise? ___________
Managerial: How many employees did you directly supervise? ___________
Total number of employees managed (directly and through subordinate supervisors): _________
EMPLOYMENT HISTORY - CONTINUED
References List three professional references with direct knowledge of your work experience.
Name
Address
Telephone Number / Email
Occupation
Email:
Email:
Email:
City of Bisbee
Personnel Department
118 Arizona Street
Bisbee, Arizona 85603
Phone: 520.432.6000 Fax 520.432.6069
personnel@BisbeeAz.gov
www.BisbeeAZz.gov
Describe any specialized training, licenses, certifications, language proficiencies or other qualifications which have not been
previously listed and which you believe relate to the position for which you are applying. Be specific in your description.
NOTICE: Due to an Arizona Supreme Court decision in 1991, if you are interviewed or selected as a finalist for a position with the
City of Bisbee, your application and resume are considered public records. Public records are required by law to be made available
during normal business hours to any person. Confidential information, such as social security number, will be redacted.
Under penalty of perjury, I hereby certify and affirm that all the information contained in this application and all
supplemental attachments is true, complete and correct. I understand that false or misleading statements or the omission
of important information made on this application or any time during the pre-hiring process may disqualify me from
employment or subject me to immediate dismissal if hired.
By signing this application, I authorize the City of Bisbee to investigate my employment background and qualifications
and perform a check of criminal convictions, and I authorize my previous employers to release to the City of Bisbee
information concerning my previous employment, education, training, experience and job performance and any other
pertinent information concerning my professional competence, ethics and qualifications for employment.
I release my prior employers and their agents, and the City of Bisbee, from any and all liability for damages of any kind
that may result to me or my family because of compliance with this authorization to release information.
Signature: __________________________________________ Date: __________________________
Employer: Job Title: _____________________________
Employer Address: _________________________________________________________________________________________
Telephone: ( ) If you are a finalist for this position may we contact?
Yes No
From: / to / Total months: Hours/ week: Salary: ___________________________
month year month year
Reason for Leaving: Name of Supervisor:
_______________________
Description of Duties: __________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____
________________________________________________________________________________________________________
Was this a supervisory or managerial position?
Yes No If Yes, please answer following questions:
Supervisory: How many employees did you directly supervise? ___________
Managerial: How many employees did you directly supervise? ___________
Total number of employees managed (directly and through subordinate supervisors): _________
Employer: Job Title: _____________________________
Employer Address: _________________________________________________________________________________________
Telephone: ( ) If you are a finalist for this position may we contact?
Yes No
From: / to / Total months: Hours/ week: Salary: ___________________________
month year month year
Reason for Leaving: Name of Supervisor:
_______________________
Description of Duties: __________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____
________________________________________________________________________________________________________
Was this a supervisory or managerial position?
Yes No If Yes, please answer following questions:
Supervisory: How many employees did you directly supervise? ___________
Managerial: How many employees did you directly supervise? ___________
Total number of employees managed (directly and through subordinate supervisors): _________
EMPLOYMENT HISTORY - CONTINUATION SHEET
118 Arizona St • Bisbee, Arizona 85603
Phone (520) 432-6000 • FAX (520) 432-6069 • TDD (520) 432-7681
Employment Application Addendum
Please complete the following and return this form with your completed application for
employment. Both application and addendum must be signed.
1. Do you have any criminal convictions (not to include civil traffic violations and juvenile
offenses)? If so, give the details below, including when and where the offense occurred
and the disposition of the case. For MOST jobs, convictions will NOT automatically be
grounds for disqualification from consideration. The failure to answer truthfully will be
grounds for disqualification.
Yes ______ No ______
Details:
2. Are you currently subject to any probation or parole orders or any civil orders that
restrict or regulate your conduct in any manner? If so, please explain fully.
Yes ______ No ______
Details:
I hereby certify that all statements contained herein are true to the best of my
knowledge and I understand omissions or misstatements may be cause for rejection of
this application, removal of my name from an eligibility list or discharge from the City of
Bisbee, regardless of the time of discovery.
Signature: _________________________________________Date: __________________
118 Arizona St • Bisbee, Arizona 85603
Phone (520) 432-6000 • FAX (520) 432-6069 • TDD (520) 432-7681
Authorization and Consent To Disclosure
Date ___________________ (Expires six months from this date unless revoked earlier.)
I understand that all information provided to the City of Bisbee is subject to verification.
To assist the City of Bisbee in processing my employment application, the undersigned
applicant for employment hereby authorizes any employer or prior employer,
educational institution, law enforcement agency, consumer reporting agency,
governmental agency, or any person or organization possessing employment,
educational or police record information concerning me to release all such information
to the City of Bisbee, its agents and employees.
Name: ________________________________________________________________________
Date of Birth: ______________________ SS# _______________________________________
Maiden Name: _______________________________________________________________
Other Name(s) Used: __________________________________________________________
Driver’s License #: ______________________________ State: ________________________
I specifically authorize the City of Bisbee, through its designated representatives, to view,
copy, be furnished copies and be given details of all such employment information,
educational records, police records and financial information, specifically to include credit
history information.
__________________________________________________________________________________
Any copy of this authorization shall have the same authority as the original.
Signature _________________________________________________________________________
Address __________________________________________________________________________
118 Arizona St • Bisbee, Arizona 85603
Phone (520) 432-6000 • FAX (520) 432-6069 • TDD (520) 432-7681
Employment Application
Addendum
For Positions Within The Police Department, The Fire Department
And Certain Public Works And Other Department Positions
In accordance with the Drug-Free Workplace Act of 1988, the City of Bisbee, as a federal
grant recipient, is required by federal law to certify to agencies from which it receives grants
that it ensures a drug-free workplace.
Accordingly, on August 17, 1990, the City of Bisbee’s “Drug Free Workplace Policy” went into
effect. The policy requires that all successful applicants for positions with the Police
Department, the Fire Department, and certain positions within the Public Works and other
Departments, must pass a screening for drugs and alcohol. Confidentiality of test results is
maintained.
As a condition of hire, I understand that I will be asked to sign a pre-employment drug
screening form. Failure to do so, or a failure to pass said testing, will result in an automatic
disqualification of my application for employment as:
Position Applied For: __________________________________________________________________
Signature: _____________________________________________ Date: _____________________
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