Fillable Village of Johnson Creek APPLICATION FOR EMPLOYMENT

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Village of Johnson Creek APPLICATION FOR EMPLOYMENT

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Village of Johnson Creek
125 Depot Street
P.O. Box 238
Johnson Creek, WI 53038
Phone (920) 699-2296
Fax (920) 699-2292
www.johnsoncreek-wi.us Crossroads with a Future
APPLICATION FOR EMPLOYMENT
The Village of Johnson Creek is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on
any basis including race, color, religion, creed, gender, national origin, age, disability, genetic information, gender, citizenship,
identity/reassignment, marital or veteran status, sexual orientation, pregnancy or maternity or other status covered by applicable
state or federal employment laws or regulations.
(Please Print or Type)
Personal Information
Last name: First name: M.:
Street address:
City: State: Zip:
Home phone: Cell phone:
Email address: Soc. Sec. #:
Do you hold a valid Driver’s License? Yes No C.D.L. License? Yes No
Driver’s License Number: ______________________________
Referral Source: Advertisement Website Friend or Relative Other_______________
Employment Desired
Position: Date you can start:
Full or Part Time: Are you presently employed?
Employer’s name: Supervisor’s name:
If yes, may we contact your supervisor? Supervisor’s phone:
Education
(Attach copies of transcripts, diplomas and/or certificates-except high school)
Did you graduate from high school? Yes No OR Do you have a GED Equivalency? Yes No
Name & Location:
TRAINING BEYOND HIGH SCHOOL:
Name & Location Dates Attended
From To
Credits
Earned
Minor/Major Degree/Date
Village of Johnson Creek 2
Employment Application
Special Studies/Research Work/Hobbies/Certifications
Other Work Experience
(most recent first)
Type of Work Dates Employer/Location Supervisor Name/Phone Reason for Leaving
Criminal History
Please list ALL instances in which you were convicted as an ADULT for crimes (misdemeanors or felonies), ordinance
violations, traffic violations and the like. Also, please list all criminal charges (misdemeanors or felonies) currently pending
against you. Failure to include all information requested under this section may result in denial of employment. Have you
been convicted or have charges pending, as listed above?
Please Check: Yes No If yes, please explain below (attach additional pages if necessary)
Date Location Charge Court Disposition of Case
NOTE: A conviction record or pending arrest record does not constitute an automatic bar to employment and will be
considered only if there is a substantial relationship to the circumstances of the particular position or if the Village deems
there is a bona fide occupational qualification inherent in the position which requires this information prior to hiring.
References
(At least three persons not related to you and who you have known for at least one year)
Name:
Address:
Phone:
Business:
Relatio
nship:
Years known:
Name:
Address:
Phone:
Business:
Relatio
nship:
Years known:
Name:
Address:
Phone:
Business:
Relatio
nship:
Years known:
I authorize investigation of all statements contained in this application. I understand omission or misrepresentation of
facts is cause for dismissal. I further understand and agree my employment is subject to probation and thereafter my
employment will be considered “at will.” I further understand the Village of Johnson Creek has high standards of
trust, honesty and integrity in its employees which I am willing and able to meet.
Date: Signature:
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Village of Johnson Creek APPLICATION FOR EMPLOYMENT

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Completed 19 April 2021

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