CITY OF BEREA
SEASONAL EMPLOYMENT APPLICATION
PLEASE PRINT:
________________________________ ____________________________________
Position Applied For Date of Application
Last Name First Name M.I.
Address City State Zip
___________________________ ____________________ ________________________
Home Phone Cell Phone (or alternate) Social Security Number
___________________________ ____________________ _____________
Date of Birth (If under 18 years of age) Driver’s License Number DL State of Issue
If you are under 18 years of age, can you provide required proof of your eligibility to work? ____ _____
Yes No
Have you ever been employed with the City of Berea before? ____ ____
If yes, please give date and department ______________________________________
Yes No
Are you currently employed? ____ ____
Yes No
May we contact your present employer? ____ ____
Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
(Proof of Citizenship or immigration status will be required upon employment) ____ ____
Yes No
On what date would you be available for work? ___________________________________
How many hours are you willing to work per week?
____ 10-20 ____ 21-30 ____ 31-40
Are you willing to work overtime if necessary? ____ ____
Yes No
Have you been convicted of a felony within the last seven (7) years? ____ ____
Conviction will not necessarily disqualify an applicant from employment Yes No
If yes, please explain: ___________________________________________________
LIFEGUARD APPLICANTS ONLY
Upon Hire, what size t-shirt and swimsuit would you prefer?
_________ T-Shirts (S-2XL) _________ Swimsuit (Male: sizes S-2XL, Female: Use waist sizes 28-48)
CONCESSION APPLICANTS ONLY
Upon hire, what size T-Shirt would you prefer? _____ (S-2XL)
Do you have a current Food Handler’s Card? ____ Yes ____ No Expiration: ________________
EDUCATION:
High School Undergraduate College
or University
Graduate or
Professional School
School Name and
Location
Years Completed
Date Graduated
Diploma/Degree
Describe any training, skills, or certifications you have completed that would aid in your ability to perform the
position applied for:
Are you involved with any activities/sports that may prohibit you from working a full schedule? If yes, please
them:
REFERENCES:
Give name, address, and phone number of three (3) references that are not related to you and are not previous
employers:
1. ___________________________________________________________________________________
2. ___________________________________________________________________________________
3. ___________________________________________________________________________________
Are you capable of performing in a reasonable manner, with or with a reasonable accommodation, the activities
involved in the job for which you have applied? A description of the activities involved in each job is available
upon request. Yes ____ No ____
EMPLOYMENT EXPERIENCE
Start with your present or last job. Include any job-related military service assignments and volunteer activities.
You may exclude organizations that indicate race, color, religion, gender, national origin, handicap or other
protected status. If you need additional space, please continue on a separate sheet of paper.
1. Employer: ______________________________________ Address: _________________________________
City ___________________________________________ State ________ Zip ________________________
Telephone Number: ______________________________ Job Title: _________________________________
Supervisor: _____________________________________ Dates Employed: From _________ To _________
Reason for leaving: ________________________________________________________________________
2. Employer: ______________________________________ Address: _________________________________
City ___________________________________________ State ________ Zip ________________________
Telephone Number: ______________________________ Job Title: _________________________________
Supervisor: _____________________________________ Dates Employed: From _________ To _________
Reason for leaving: ________________________________________________________________________
APPLICANT'S STATEMENT:
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of
all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 60 days. Any
applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications
are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment
relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the
Employer may discharge the Employee at any time with or without cause. It is further understood that this “at will
employment relationship may not be changed by any written document or by conduct unless such change is specifically
acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or
interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the
employer.
__________________________________________________________ ________________________
Signature of Applicant Date
Employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or
veteran status, medical condition or handicap, or any other legally protected status. As an employer with an Affirmative
Action Program, we comply with government regulations, including Affirmative Action responsibilities where they apply.
APPLICATION PROCESS:
To receive consideration, applicants must complete this application in full. If a resume is submitted for part of
the information requested on this application, applicants must be certain that the resume contains all of the
information on this application.
PLEASE RETURN COMPLETED APPLICATION TO:
IN PERSON: BEREA PARKS & REC OFFICE – 5 PIRATE PARKWAY
BY MAIL: CITY OF BEREA, ATTN: HUMAN RESOURCES 212 CHESTNUT ST, BEREA, KY 40403
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