Fillable HAINES BOROUGH, ALASKA EMPLOYMENT APPLICATION (Haines Borough)

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HAINES BOROUGH, ALASKA EMPLOYMENT APPLICATION (Haines Borough)

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U.S.A. forms for Haines Borough

BROWSE HAINES BOROUGH (AK) FORMS

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EMPLOYMENT APPLICATION
HAINES BOROUGH, ALASKA
P.O. BOX 1209, HAINES, AK 99827
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 do not send photographs of applicant with
application. Once submitted to the Borough, applications become public record and are subject to public review.
Conditions of employment are stated at the end of this application. Please read it carefully before signing.
(PLEASE PRINT OR TYPE)
IF REQUESTED INFORMATION IS INCLUDED ON AN ATTACHED RESUMÉ, YOU MAY INDICATE "SEE RESUMÉ"
Position Applied For
Date of Application
Last Name First Name Middle Name
Mailing Address City State Zip Code
Telephone Number Other Telephone E-mail
If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No
Best time to contact you at home is: ____:____am/pm
Are you currently employed? Yes No
May we contact you at work? Yes No If so, Phone # __________ Best time: ____:____am/pm
May we contact your present employer? Yes No
Have you ever been employed by the Haines Borough before? Yes No
If yes, give dates _________________ to __________________
Are you legally eligible for employment in the United States? Yes No
Proof of identity and eligibility will be required upon employment
Can you travel if the job requires it? Yes No
Date you can be available to start work ____/____/____
Check all times you are available to work:
____ Full Time ____ Part Time ____ Shift Work ____ Temporary ____Flexible Schedule
____ Mornings ____ Afternoons ____ Evenings ____ Weekends
In the last ten years, have you been convicted of a felony or a misdemeanor that resulted in imprisonment? Yes No
Conviction will not necessarily disqualify an applicant from employment. The Borough will consider such factors as the amount of time that has
elapsed since the conviction and the seriousness and nature of the crime.
If yes, explain ______________________________________________________________________________
Have you ever been discharged from employment or asked to resign? Yes No
If yes, explain: _____________________________________________________________________________________
THE HAINES BOROUGH IS AN EQUAL OPPORTUNITY EMPLOYER
Haines Borough EMPLOYMENT APPLICATION Page 2
EDUCATION
School
Name and Address
of School
Course of Study
Years
Completed
Diploma/ Degree
Received
High School
Undergraduate
College
Graduate/
Professional
Other
(Specify)
WORK EXPERIENCE
Start with your most recent job, and include any job-related military service assignments and volunteer activities. You may exclude
organizations that could indicate race, color, religion, gender, national origin, disabilities or other protected status.
Employer
Dates Employed
Work Performed
Address
From To
Telephone Number(s)
Job Title
Hourly Rate/Salary
Starting Final
Supervisor
May We Contact Supervisor? Yes No
Reason for Leaving
Employer
Dates Employed
Work Performed
Address
From To
Telephone Number(s)
Job Title
Hourly Rate/Salary
Starting Final
Supervisor
May We Contact Supervisor? Yes No
Reason for Leaving
Employer
Dates Employed
Work Performed
Address
From To
Telephone Number(s)
Job Title
Hourly Rate/Salary
Starting Final
Supervisor
May We Contact Supervisor? Yes No
Reason for Leaving
Employer
Dates Employed
Work Performed
Address
From To
Telephone Number(s)
Job Title
Hourly Rate/Salary
Starting Final
Supervisor
May We Contact Supervisor? Yes No
Reason for Leaving
Comments: Include explanation of any gaps in employment.
Haines Borough EMPLOYMENT APPLICATION Page 3
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
List professional, trade, business or civic activities you consider relevant to your ability to perform the job.
Other Qualifications: Summarize special job-related skills and qualifications acquired from employment or other experience.
Specialized Skills – Circle all that apply to you
PC
MAC
Databases
Spreadsheets
Word Processing
Desktop Publishing
Website Content Mgmt
Accounting
Other (please specify)
_____________________________
SOFTWARE
MS Word
MS Excel
MS Publisher
MS Access
Filemaker Pro
Adobe Acrobat Pro
ArcGIS
Other (please specify)
_____________________________
MACHINERY/EQUIPMENT
(please specify)
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
State any additional information you feel may be helpful to us in considering your application, especially
determining if you meet the required minimum qualifications. (Attach additional sheet, if necessary.)
Note: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS
AND ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing, with or without a reasonable accommodation, the essential functions of the job for which
you have applied? A summary of the essential functions involved in the job or occupation has been given.
YES NO
Personal/Professional References Do not include family members or past supervisors listed above
Name Phone No. Address Occupation
1.
2.
3.
Haines Borough EMPLOYMENT APPLICATION Page 4
It is the policy of the Haines Borough to afford equal opportunity to all employees and applicants for employment without regard to
age, race, religion, color, sex, sexual orientation, national origin, marital status, expunged juvenile records, or pregnancy, and to
afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, and any other
characteristic protected by federal, state or local law.
The following information is being gathered for compliance with civil rights laws. You may choose not to complete this section.
If you choose to, your answers will be used ONLY for record-keeping and employee data reporting purposes if you are hired. This
voluntary information will not be used in the hiring process.
Gender: Male Race: Alaskan Native or American Indian
Female Asian
Black or African American
Age: Under 40 years old Hispanic or Latino
Age 40 or older Native Hawaiian or other Pacific Islander
White, not of Hispanic origin
Rev. 8/16
NOTIFICATION AND AGREEMENT
Please Read Carefully Before Signing
I CERTIFY THAT ALL MY RESPONSES ARE TRUE, ACCURATE AND COMPLETE. I
UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF
ANY FACT ON THIS APPLICATION (OR ANY OTHER STATEMENT OR DOCUMENT)
WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF
EMPLOYMENT, REGARDLESS OF WHEN OR HOW DISCOVERED.
Questions regarding this statement should be directed to any employment interviewer before signing. Receipt of
the application does not imply that the applicant will be employed.
By my signature below, I consent to the Borough’s conferring with any and all of my former employers
concerning my performance and reviewing publicly available documents and databases relevant to my application.
I understand that the Borough will treat all such information as it would any personnel record, and I release the
Borough and its management from all liability related to any action to which I have consented herein.
If hired, I agree to abide by all of the Borough’s rules and regulations. I understand that the Borough shall have
the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise
change all policies, procedures, benefits and other terms or conditions of employment.
I hereby affirm that the information given in this Application is true and correct to the best of my knowledge. I
have not knowingly withheld any fact or circumstance that would, if disclosed, affect my application unfavorably.
I authorize the investigation of all statements and information contained in this application. I release from all
liability anyone supplying such information and I also release the employer from all liability that might result
from making an investigation.
I understand that any misrepresentation, deception, or false statement made in this Employment Application may
result in my not being considered for employment, and if not discovered by the Borough until after my becoming
employed, is grounds for, and may result in, my immediate termination.
I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the
information I have supplied on this application.
APPLICANT SIGNATURE _______________________________________ DATE _______________
OPTIONAL INFORMATION
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HAINES BOROUGH, ALASKA EMPLOYMENT APPLICATION (Haines Borough)

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Completed 21 January 2021

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