Employment Application

PERSONAL INFORMATION

Name

Email

Phone Number

Applying for Position / Title

Date Available to Work

Availability (Select all that apply)

EDUCATION & TRAINING

High school diploma or GED?

Yes

No

Select highest grade level

+ -

Colleges or Universities

Field of Study

Did you graduate

Yes

No

Technical, Vocational or Business School

Field of Study

Did you graduate

Yes

No

Special Training

List any special training program or courses you have attended which you feel may add to your qualifications. List course, date, and institution (including military training)

Special Skills / Qualifications

List special skills or qualifications (not listed above) you possess which you believe further you for the position for which you are applying (include computer languages, types of computer software, word processing, typing speed, specialized equipment or machines, tools, vehicles, heavy equipment or memberships).

GENERAL INFORMATION

Driver's License Number and State

Type of driver's license

CDL Endorsement(s)

Tank Vehicle

Double / Triple Trailer

Hazardous Materials

Passenger

Dismissals and / or Forced Resignations

Have you ever been fired or forced to resign from any position?

Yes

No

If yes, please explain below:

Have you ever been convicted of a MISDEMEANOR or FELONY and / or fined or given a suspended sentence such as deferred adjudication in court? List all cases other then minor traffic violations. PLEASE NOTE: A full disclosure by you is to your advantage as your record does not constitute an automatic bar to employment. Factors such as, but not limited to, age at the time of the offense(s) and recencey of the offence(s) as well as the relationship between the offense(s) and the job(s) for which you apply will be taken into consideration. HOWEVER, FAILURE TO SUBMIT CONVICTIONS WILL RESULT IN DISQUALIFICATION OF YOUR APPLICATION FOR ONE YEAR.

Convicted of a misdemeanor or felony

Yes

No

If YES, please provide the following:

Date

Charge

City / State

Disposition

If you need additional space, please list the information below in the same format:

Have you ever been employed by the City of Hawley?

Yes

No

If yes, please list the title of your position

Are you related to any elected / appointed official or any person currently employed by the City of Hawley?

Yes

No

If yes, please indicate:

Name

Relationship

Position

EMPLOYMENT HISTORY

In the spaces provided below, give your employment history beginning with you present or most recent employer. List each position held (even those with the same employer), include military, part-time, summer, volunteer work, and any periods of unemployment.

Current or Most Recent Employer

Start Date

End Date

Address / City / State

Phone Number

Job Title

Supervisor Name and Title

Reason for Leaving

Briefly describe the nature and duties of your position

Employer #2

Start Date

End Date

Address / City / State

Phone Number

Job Title

Supervisor Name and Title

Reason for Leaving

Briefly describe the nature and duties of your position

Employer #3

Start Date

End Date

Address / City / State

Phone Number

Supervisor Name and Title

Job Title

Supervisor Name and Title

Reason for Leaving

Briefly describe the nature and duties of your position

Explanation of any periods of unemployment between jobs:

I certify that I have read and fully understand this form in its entirety and that the information provided is true and complete to the best of my knowledge. I understand that should nay statement I have made prove false, misleading, or erroneous, it may result in the rejection of my application or discharge from the City of Hawley service. In submitting this application, I authorize the City of Hawley to verify all data needed to support this application and to obtain references from my present and past employers. I further understand that his application becomes the property of the City of Hawley and will not be returned.

Yes

No

I also understand that I will have the right to terminate my employment with the City of Hawley at any time without notice and for any reason. I understand that the City of Hawley has the same right. If required for the position, I also understand that as a condition of employment I will be subjected to one or more of the following: driving record check, criminal history investigation, medical examination and / or pre-employment drug-alcohol screening test. An employment offer received from the City is contingent upon information received.

Yes

No