Application for Employment
Position(s)
Date of Application
How did you learn about us?
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Relative
Inquiry
Employment Agency
Friend
Other: ____________________
Last Name
Middle name
Physical Address (Number)
City
Zip
Mailing Address (Number)
City
Zip
Home Number
E-Mail Address
Best time to contact you at home is?.......................................................................................
If you are under 18 years of age, can you provide required proof of your eligibility to
work?.......................................................................................................................................
Yes No
Have you ever filed an application with us before?.................................................................
Yes No
Do any of your friends or relatives, other than spouse, work here?........................................
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
Date available for work _____ / _____ / _______ What is your desired salary range? $_______________
Are you available to
work:
Full-Time (Please indicate shift: )
TOWN OF HUACHUCA CITY
500 N. Gonzalez Blvd. Huachuca City, AZ
85616 520-678-1849 - Fax 456-2230
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Part-Time (Please indicate shift: )
Temporary (Please Indicate) Start End
Are you currently on “lay-off” status and subject to recall?......................................................
Yes No
Can you travel if the job requires it?........................................................................................
Yes No
Education
Name & Address of School
Course of Study
Years Completed
Diploma/Degree
Elementary School
High School
Undergraduate
School
Graduate
Professional
Other
(Specify)
Describe any specialized training, apprenticeship, skills and extracurricular activities that may be beneficial during
employment.
Describe any job-related training received in the United States Military.
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Employment History
Start with your present or last job. Include any job-related military service assignments and volunteer activities.
You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.
Employer
Dates Employed
Work Performed
From
To
Address
Telephone Number(s)
Hourly Rate/Salary
Starting
Final
Job Title
Supervisor
Reason for Leaving
Employer
Dates Employed
Work Performed
From
To
Address
Telephone Number(s)
Hourly Rate/Salary
Starting
Final
Job Title
Supervisor
Reason for Leaving
Employer
Dates Employed
Work Performed
From
To
Address
Telephone Number(s)
Hourly Rate/Salary
Starting
Final
Job Title
Supervisor
Reason for Leaving
Employer
Dates Employed
Work Performed
From
To
Address
Telephone Number(s)
Hourly Rate/Salary
Starting
Final
Job Title
Supervisor
Reason for Leaving
HC_EmploymentApp_rev1_June2015
List Professional, Trade, Business or Civic Activities and Offices Held
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.
Additional Information
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
State any additional information you feel may be helpful to us in considering your application.
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN
INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities
involved in the job or occupation for which you have applied? A review of the activities involved in such a job or
occupation has been given.
Yes No
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Applicant’s Statement
I certify that my answers given herein are true and complete.
I authorize the Town of Huachuca City and its authorized entities to investigate all statements
contained in this application for employment as may be necessary when determining an applicant’s
employment status.
This application for employment shall be considered active for a period of time not to exceed 45
(forty-five) 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.
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 Town of Huachuca City.
_______________________________ ______________
Applicant’s Signature Date
For Personnel Department Use Only
Position(s) Applied For is Open: Yes No
Positions Considered For: __________________________________________
__________________________________________
Date: ______________________
Arrange Interview: Yes No
Remarks: ________________________________________________________
________________________________________________________
________________________________________________________
Employed: Yes No Date of Employment: ____________________
Job Title: _________________________ Hourly Rate/Salary: _____________________
Department: _________________________
By: _________________________ ________________________
Name and Title Date
Electronic Application Submission
I hereby confirm everything contained in this application is true and accurate and am electing to submit my
application for employment with the Town of Huachuca City, electronically.
Initials
Date
HC_EmploymentApp_rev1_June2015
Submit Application
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click to sign
signature
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