Fillable Town of Springerville 418 E. Main Street Springerville, (Town of Springerville)

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Town of Springerville 418 E. Main Street Springerville, (Town of Springerville)

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The Town of Springerville 418 E. Main Street Springerville, (Town of Springerville) form is 4 pages long and contains:

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  • 2 check-boxes
  • 78 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Springerville

BROWSE TOWN OF SPRINGERVILLE (AZ) FORMS
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1
Town of Springerville
418 E. Main Street
Springerville, AZ 85938
(928) 333-2656
Fax (928) 333-3056
Application For Employment
READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE FILLING OUT
YOUR APPLICATION FOR EMPLOMENT. TYPE OR PRINT CLEARLY IN INK ONLY.
All requested information must be furnished. If an item does not apply to you, or if there
is no information to be given, write in letters “NA” for Not Applicable. All information
contained on the application is subject to verification. Any omissions or misstatements
may be cause for rejection of this application, removal of your name from an eligibility
list, or discharge from the Town. Note, for completing “Employment History”: Fill in ALL
spaces accurately and completely. List all work/volunteer experience which is related to
the job for which you are applying.
POSITION APPLIED FOR: __________________________________________
Your Name: _________________________________
Your Phone Number: __________________________
Are you over 18 years of age? Yes No ______
THE TOWN OF SPRINGERVILLE IS AN EQUAL OPPORTUNITY EMPLOYER AND
COMPLIES WITH AMERICANS WITH DISABILITIES ACT.
How did you learn of this position/job?
Newspaper
From a friend
Facebook
Other (Specify) _________________________
EMPLOYMENT QUESTIONS
A. Are you a U.S. Citizen or do you have the legal right to remain permanently in the
U.S.? Yes No
B. If required to drive a town vehicle do you possess a valid AZ driver’s license?
Yes No License No.: ________________ Expiration Date: ____________
C. Have you ever worked for the Town of Springerville?
Yes No When? ____________________
D. Are any of your relatives, either by blood or marriage, employed by the Town of
Springerville? Yes No
E. Except for minor traffic violations, were you ever convicted of any federal, State,
Local or military law or statute? Yes No
F. Have you ever been discharged or requested or forced to resign from any position?
Yes No
G. Do you have any reason to believe you will be requested to resign from your current
Clear Form
2
No position within the next thirty days? Yes
H. Have you ever served in the Armed Forces?
Yes No Branch: ____________ Dates: ______________
No I. Are you eligible to be registered for selective service? Yes
J. Have you registered for selective service? Yes No
K. If the answer is “yes” to questions D, E, F & G, please explain in the space below
(An explanation does not preclude employment).
A RESUME MAY BE SUBMITTED IN PLACE OF EDUCATION AND EMPLOYMENT
HISTORY.
EDUCATION
Did you receive a High School diploma or G.E.D diploma? Yes No Date: _____
Name(s) of Colleges or Universities attended, dates attended, courses taken or degrees
earned
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Trade, Technical, Correspondence, or other courses taken, dates attended, courses
studied and completion date
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Other recognition, awards or associations that you have received or are a member of:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
PRE-EMPLOYMENT REVIEW
A background check, a drug/alcohol screening, a physical examination or other pre-
employment screening will be required for the job you are applying for and an offer of
employment will be contingent upon your passing said examination(s).
National Guard
3
EMPLOYMENT HISTORY
PRESENT OR MOST RECEENT JOB:
Employer: _____________________________________________________________
Location: ______________________________________________________________
Kind of Business: _______________________________________________________
Your Title: _____________________________________________________________
Name and Title of Supervisor: _____________________________________________
May we contact your supervisor/employer: Yes No
Described the major functions or duties you performed:
Dates of Employment: ___________________________________________________
Reason for Leaving: _____________________________________________________
SECOND MOST RECEENT JOB:
Employer: _____________________________________________________________
Location: ______________________________________________________________
Kind of Business: _______________________________________________________
Your Title: _____________________________________________________________
Name and Title of Supervisor: _____________________________________________
May we contact your supervisor/employer: Yes No
Described the major functions or duties you performed:
Dates of Employment: ___________________________________________________
Reason for Leaving: _____________________________________________________
4
RERFERENCES
Provide at least three (not related to you) who have known you for at least five (5) years
Name: ___________________________ Phone: ______________________________
Location: _____________________________________________________________
Name: ___________________________ Phone: ______________________________
Location: _____________________________________________________________
Name: ___________________________ Phone: ______________________________
Location: _____________________________________________________________
OTHER
Please share any additional comments that the hiring panel should consider as they
review your application:
I herby certify and represent that all information given on this application and any
supporting information is true and complete. I understand that any falsification or
material omission of information is grounds for refusal to hire or, if hired, are grounds for
termination. I herby grant the Town of Springerville permission to contact any person or
organization and question them about my job-related suitability. I understand that the
application with all the its attachments will be the property of the Town of Springerville
and considered a public record under the Arizona State law and therefore subject to
release without notice. I will keep the Town Clerk advised about any changes of
address or telephone number so long as I am employed or being considered for
employment by the Town of Springerville.
Signature: _______________________________ Date: ________________________
Date Application Received: ___________________________
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Town of Springerville 418 E. Main Street Springerville, (Town of Springerville)

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Completed 19 January 2021

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