Please print or type. The
application must be fully
completed to be
considered. Please
complete each section,
even if you attach a
resume.
Personal Information
Name
Address City State Zip
Phone number Email address
Are you legally eligible to work in the US?
Yes No
If selected for employment a background check will be completed
Position
Position you are applying for Available start date Desired pay
Employment desired
Full time
Part time Seasonal/Temporary
Education
School name Location Years attended Degree received Major
References (business and professional only)
Name Title Company Phone
No
We are an Equal
Opportunity Employer and
committed to excellence
through diversity.
Are you a veteran?
Yes
Application For Employment
City of Liberty Lake
22710 E. Country Vista Drive
Liberty Lake, WA 99019
Do you have relatives
working for this
organization?
Yes No
Form Updated 6/2019
Employment History
Employer (1)
Job title Dates employed
Work phone
Address
City
State
Zip
Employer (2)
Job title Dates employed
Work phone
Address
City
State
Zip
Employer (3)
Job title Dates employed
Work phone
Address
City
State
Zip
Employer (4)
Job Title
Dates employed
Work phone
Address
City
State
Zip
Employer (5)
Job title Dates employed
Work phone
Address
City
State
Zip
Signature Disclaimer
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my employment being terminated.
Name (please print)
Signature
Date
Reason for leaving
Reason for leaving
Reason for leaving
Reason for leaving
Reason for leaving
Form Updated 6/2019
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signature
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