City of Cayce Application for Employment- Revised 2019 Page 1
APPLICATION FOR EMPLOYMENT
This application form is intended for use in evaluating your qualifications for employment. All qualified applicants will receive
consideration without regard to sex, race, color, age, creed, national origin, religion, disability, veteran status, uniformed
servicemember, genetic information, or any other category protected by applicable federal, state, or local laws, regulations or
ordinances. No question on this application is intended to secure information to be used for such discrimination. Testing of job-
related skills may be required prior to employment.
THE CITY OF CAYCE IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. EMPLOYMENT AT-WILL MEANS THAT
REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR THE EMPLOYEE MAY TERMINATE THE
EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.
Name ___________________________________________________ Position Applied For __________________________
Last First Middle Initial
Telephone Number (_____) _________________ Alternate/Cellular Telephone Number (_____) ________________
Email Address ________________________ Emergency Contact Name and Number ______________________
Current Address ______________________________________________________________________________________
Street, Apartment, or Unit Number
_______________________________ _______ ___________ How long have you lived there _____/_______
City State Zip Years Months
Previous Address _____________________________________________________________________________________
Street, Apartment, or Unit Number
_______________________________ _______ ___________ How long have you lived there _____/_______
City State Zip Years Months
Desired Salary/Hourly Rate ____________________ Are you over the age of 18? Yes No
Type of employment desired? Full-time Part-time (Specify Hours) ___________________________
Are you willing to work overtime? Yes No Date on which you can start work if hired __________________
Do you have the right to work in the United States? Yes No
Have you previously applied for employment with the City of Cayce? Yes No
If Yes, when and where did you apply? ______________________________________________________________________
Have you ever been employed by the City of Cayce? Yes No If Yes, provide dates of
employment, location, and reason for separation from employment.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
How were you referred to the City of Cayce __________________________________________________________________
If referred by an employee of the City of Cayce please include their name __________________________________________
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City of Cayce Application for Employment- Revised 2019 Page 2
APPLICATION FOR EMPLOYMENT
Have you ever plead guilty or no contest to, or been convicted of any criminal offense? Yes No
CRIMINAL OFFENSES ONLY: If you answered Yes, to the above question, please provide the date(s) and an explanation.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Criminal convictions or arrests will not automatically disqualify an applicant from a particular job. The City of Cayce will
consider the nature of the crime, its seriousness, the substantial relation to the position’s functions and qualifications, the
number of occurrences, the applicant’s age at the time of the crime, the time elapsed since the crime, the applicant’s entire
work and educational history, employment references and recommendations, and the business necessity of any exclusion
when required by law.
List all certifications or special technical skills that you feel qualify you for the job for which you are applying (For example,
CDL, CPA, PE, Water or Wastewater Certificate.)
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Education
School Name and Location
(Address, City, and State)
Course of Study
Graduate?
Degree/Major
High School
College
Business/Technical/
Trade or Post
College
Honors Received _________________________________________________________________________________________
If applicable, list below any other names by which you have been known which may be necessary to allow us to confirm your
work and educational record. For example, change of name, use of an assumed name, nickname, etc.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Please list the names of your present and/or previous employers in chronological order with most current or last employer
listed first. Account for all periods of time including any period of unemployment. If self-employed, supply operating name
and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service.
Failure to completely respond to each inquiry may disqualify you for consideration from employment. You may attach
additional pages if necessary.
WORK EXPERIENCE
Yes
4
N/A
N/A
N/A
N/A
City of Cayce Application for Employment- Revised 2019 Page 3
APPLICATION FOR EMPLOYMENT
Employer:
___________________________________ ____________________________________ _______________________
Name Address Type of Business
Telephone (______) __________________ Dates Employed From ___________ To __________
Job Title ___________________ Duties ________________________________________________________________
Supervisor’s Name _____________________ May we contact? Yes No If No, why not? ___________________
Wages: Start _______ Final _______ Reason for Leaving __________________________________________________
What will this employer say was the reason your employment was terminated? ___________________________________
How much notice did you give when resigning? If no notice provided, explain. ___________________________________
Employer:
___________________________________ ____________________________________ _________________________
Name Address Type of Business
Telephone (______) __________________ Dates Employed From ___________ To __________
Job Title ___________________ Duties _________________________________________________________________
Supervisor’s Name _____________________ May we contact? Yes No If No, why not? ___________________
Wages: Start _______ Final _______ Reason for Leaving __________________________________________________
What will this employer say was the reason your employment was terminated? ___________________________________
How much notice did you give when resigning? If no notice provided, explain. ___________________________________
Employer:
___________________________________ ____________________________________ _______________________
Name Address Type of Business
Telephone (______) __________________ Dates Employed From ___________ To __________
Job Title ___________________ Duties _________________________________________________________________
Supervisor’s Name _____________________ May we contact? Yes No If No, why not? ___________________
Wages: Start _______ Final _______ Reason for Leaving __________________________________________________
What will this employer say was the reason your employment was terminated? ___________________________________
How much notice did you give when resigning? If no notice provided, explain. ___________________________________
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City of Cayce Application for Employment- Revised 2019 Page 4
APPLICATION FOR EMPLOYMENT
Please explain fully all gaps in your employment history in excess of one month.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Have you ever been terminated or asked to resign from any job? Yes No
Has your employment ever been terminated by mutual agreement? Yes No
Have you ever been given the choice to resign rather than be terminated? Yes No
If you answered Yes to any of the above three questions, please explain the circumstances of each occasion.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
REFERENCES
Please list the names of additional work-related references we may contact. Individuals with no prior work experience may
list school or volunteer-related references.
NAME
POSITION
COMPANY
WORK RELATIONSHIP
(Supervisor, Co-Worker)
TELEPHONE/EMAIL
I certify that all the information on this application, my résumé, or any supporting documents I may present during any
interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification,
misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if
employed, disciplinary action, up to and including immediate termination.
THE CITY OF CAYCE IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF
ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP
AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR IN ANY
DOCUMENT OR STATEMENT, WRITTEN OR ORAL, SHALL LIMIT THE RIGHT TO TERMINATE EMPLOYMENT AT-WILL. NO
OFFICER, EMPLOYEE OR REPRESENTATIVE OF THE COMPANY IS AUTHORIZED TO ENTER INTO AN AGREEMENTEXPRESS OR
IMPLIEDWITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH
AN AGREEMENT IS IN A WRITTEN CONTRACT SIGNED BY THE CITY MANAGER OF THE CITY.
IF HIRED, I AGREE TO CONFORM TO THE POLICIES, RULES, AND REGULATIONS OF THE COMPANY, AND I UNDERSTAND THAT
THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH POLICIES, RULES AND REGULATIONS AT ANY TIME, EXCEPT
THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL.
APPLICANT CERTIFICATION
City of Cayce Application for Employment- Revised 2019 Page 5
APPLICATION FOR EMPLOYMENT
I authorize the City of Cayce or its agents to confirm all statements contained in this application and/or résumé as it relates to
the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite
authorization forms for the required employment screening process.
I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-
mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local
law, any party delivering information to the City of Cayce or its duly authorized representative pursuant to this authorization
from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above
requested information. I hereby release from liability the City of Cayce and its representative for seeking such information and
all other persons, corporations, or organizations furnishing such information.
I agree to submit to a pre-employment drug testing. I understand that testing positive for the use of any illegal drug, abuse of
a legal drug, use of a non-prescribed legal drug, refusal to take the test, or failure to keep the scheduled appointment for the
test will generally result in denial of employment with the City of Cayce. If hired by the City of Cayce, I understand that I will
be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United
States by this Company. I also understand that the City of Cayce employs only individuals who are legally eligible to work in
the United States.
I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE, AND
COMPLETE.
Applicant Signature _________________________________________ Date ____________________________
THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF 1 YEAR. IF YOU WISH TO BE CONSIDERED FOR
EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.
Applications should be returned via email to: ldooley@caycesc.gov,
via mail to: PO Box 2004 Cayce, SC 29171-2004 or in person at 1800 12th St. Cayce, SC 29033
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