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Please download this application to your computer, fill (City of Providence)

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The Please download this application to your computer, fill (City of Providence) form is 4 pages long and contains:

  • 1 signature
  • 10 check-boxes
  • 116 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Providence

BROWSE CITY OF PROVIDENCE (RI) FORMS

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Please download this application to your computer, fill it out using
Adobe Reader, save it and then email it to: jobs@providenceri.gov
CITY OF PROVIDENCE APPLICATION FOR EMPLOYMENT
DEPARTMENT OF HUMAN RESOURCES
Position Title (Required): ________________________________________
Name (Last, First, Middle)
Address (Street)
Address (City, state, Zip Code)
Home Telephone Mobile Telephone
Email Address
Have you ever worked for the City of
Providence or any of its agencies boards or
commissions?
YES
□
NO
□
If yes, dates:
Department(s):
Are you currently receiving, or will you become
eligible to receive a pension from
the City of
Providence Retirement Plan?
YES
□
NO
□
If yes, when?
Are you receiving or will you become eligible to
receive a pension from the City of Providence
Teachers and Certified Administrators
Retirement System?
YES □
NO □
If yes, when?
If you answered yes above, are you willing to
waive your right to receive such pension or part
of such pension during this new employment
with the City (Providence Code of Ordinances
17-8)
YES
□
NO □
Are you 18 years of age or older?
YES
□
NO
□
Date of availability:
Are you currently under contract with another
employer?
YES
□
NO
□
If yes,
expiration date?
Are you able to perform the essential functions
of the job for which you are applying with or
without reasonable accommodations?
YES
□
NO
□
Are you legally eligible for employment in the
USA?
YES
□
NO
□
Control act of 1986 requires you to furnish proof of
List all languages in which you are fluent:
Have you ever been dismissed or asked to
resign from any position?
YES
□
NO
□
fully explain
Licenses -
If you are applying for a position that requires a license (i.e. driver’s license, commercial driver’s license, hoisting
engineer, arborist, etc.) you must list the type, license number, state of issuance and expiration date.
Type
License#
State
Exp. Date
Military Service Record
Have you ever served in the U.S. Armed Forces?
YES
□
NO
□
Dates of duty:
From (Month) (Year)
To (Month) (Year)
Branch of service:
Applicable skills required?
Work History – You may attach a resume to supplement the information herein this application.
1
Employer
From date: To date:
Phone #
Street Address
May we contact this employer to
gather information?
YES
□
NO
□
City, State, Zip Code
Job Title
Supervisor’s Name
Reason for Leaving
Duties Performed :
2
Employer
From date: To date:
Phone #
Street Address
May we contact this employer to
gather information?
YES
□
NO
□
City, State, Zip Code
Job Title
Supervisor’s Name
Reason for Leaving
Duties Performed :
3
Employer
From date: To date:
Phone #
Street Address
May we contact this employer to
gather information?
YES
□
NO
□
City, State, Zip Code
Job Title
Supervisor’s Name
Reason for Leaving
Duties Performed :
Educational and Professional Training
Name of Institution Location
Diploma
Degree
Major
Minor
Professional References
Name/Title
Company
Address/Phone#
Professional Organizations -
List below any job related or professional organizations of which you are a member.
Applicant’s Certification Agreement
I certify that the facts set forth in this Application for Employment are true and complete. I understand that the
false statements on this application shall be considered sufficient cause for disqualification or, if employed by the
City, dismissal. As an application for a position with the CITY OF PROVIDENCE, I hereby authorize past employers
and educational institutions to release information about my work history and education to allow the CITY OF
PROVIDENCE to determine my qualifications for the position to which I’ve applied.
All correspondence or telephone calls concerning applications or positions available should be directed to the CITY
OF PROVIDENCE, 25 Dorrance Street, Providence, RI 02903, telephone (401) 421-7740 x 5240.
www.providenceri.gov/hr.
PRINTED NAME: __________________________________________________
SIGNATURE: _____________________________________________________ DATE: ______________________
THE CITY OF PROVIDENCE IS AN EQUAL OPPORTUNITY EMPLOYER
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Completed 14 July 2020

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