Fillable Employment Application June 2017 (City and Borough of Wrangell, Alaska)

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Employment Application June 2017 (City and Borough of Wrangell, Alaska)

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Application for Employment
PRE-EMPLOYMENT DRUG SCREENING REQUIRED
205 Brueger Street (907) 874-2381
PO Box 531 FAX (907) 874-3952
Wrangell, AK 99929
www.wrangell.com
Applicant Name:_______________________ Date:___________
City and Borough of Wrangell
APPLICATION FOR EMPLOYMENT
PRE-EMPLOYMENT QUESTIONNAIRE EQUAL OPPORTUNITY EMPLOYER
PERSONAL INFORMATION
Name
Last
First
Middle
Street Address
City
State
Zip
Mailing Address
City
State
Zip
Home Phone No.
Alternate Phone No.
Are you 18 years or older?
Yes
No
EMPLOYMENT DESIRED
Position
Salary
Desired $
If so, may we inquire of
Are you employed now?
your present employer?
Have you ever worked for the City and Borough of Wrangell?
When?
Referred by:
City Website_____
Friend_____
Other____________________
REFERENCES
Give the names of three persons not related to you, whom you have known at least one year.
Name
Phone
Number
Address
Years
Acquainted
1
2
3
Permanent
Full-Time
EDUCATIONAL BACKGROUND
Are you a high school graduate or have you passed a general education development (G.E.D.) test? Yes_____ No_____
Name and Location of High School:
List colleges, universities or professional schools attended. If more space is needed, attach additional copies.
School Name & Location
Major/Minor or Course of Study
Hours
Completed
Degree
List any other job-related training or coursework: (vocational, trade, governmental, business, armed forces)
Job Related Training or Coursework
Course of Study
Hours Completed
List job-related licensure, registration or certification (trade licenses, EMT license, CLEET certification, CDL license, etc.)
License, Registration or
Certification
Number
Expiration Date
Licensing Agency or Board
List other work related skills. I.e. computer experience and/or equipment experience.
Are you prevented from lawfully becoming employed in this country because of visa or immigration status? Yes No
Are you related to any Borough Assembly Member, Mayor, or Borough Manager? Yes
No
If yes, explain relationship __________________________________________________________________
Are you related to anyone currently working with the City and Borough of Wrangell? Yes
No
If yes, explain relationship, department they work in, and name of employee? _________________________
________________________________________________________________________________________
Have you ever been convicted or pled guilt, no contest or had a suspended imposition of sentence to a crime? (This
information does not in itself disqualify you for employment) Yes
No to a felony? Yes No
“I certify that all the information submitted by me on this application and any attachments are true and complete, and I
understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected. I
understand that all job offers are made contingent upon successful completion of a pre-employment drug screen and
background check. I authorize the City and Borough of Wrangell to contact my previous employers, references, and
educational institutions regarding my background and employment history.”
Date:
Signature: ___________________________________________
EMPLOYMENT HISTORY
Begin with your current or most recent job. Include military service (indicate rank) and volunteer work. List each
promotion or transfer as a separate job, even if they were with the same employer. All information in this section must be
completed. Resumes can be attached as a substitute for this section of the application. 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's Name and Phone Number:
Title of Your Position:
Dates of employment from ____________to_____________
Examples of Duties:
Ending Salary:_____________ Supervisor's name and title:_____________________________________
Reason for leaving:_____________________________________________________________________
Employer's Name and Phone Number:
Title of Your Position:
Dates of employment from ____________to_____________
Examples of Duties:
Ending Salary:______________ Supervisor's name and title:____________________________________
Reason for leaving:_____________________________________________________________________
Employer's Name and Phone Number:
Title of Your Position:
Dates of employment from ____________to_____________
Examples of Duties:
Ending Salary:________________ Supervisor's name and title:__________________________________
Reason for leaving:_____________________________________________________________________
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Employment Application June 2017 (City and Borough of Wrangell, Alaska)

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Completed 2 July 2021

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