Employment Application 1Position Details2Contact Information & Eligibility3Education & Special Skills4Work History5References6Affidavit & Submit7Request for Criminal Record Check8Require Documents We do not discriminate on the basis of race, color, religion, national origin, sex, age, or disability. It is our intention that all qualified applicants are given equal opportunity and that selection decision be based on job related factors. Position DetailsAnswer each question fully and accurately. No action can be taken on this application until you have answered all questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job related information.Job Number(Required)Position Title(Required)This field is hidden when viewing the formDepartmentType of employment you are seeking? Full Time Part Time Seasonal/Temporary When could you start work? Contact Information & EligibilityYour Name First Middle Last Your Email Address Enter Email Confirm Email Present Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone NumberAre you 18 years of age or older?(If you are hired, you may be required to submit proof of age.) Yes No If hired, can you furnish proof you are eligible to work in the U.S.? Yes No Have you applied here before? Yes No If yes, when?Were you ever employed here? Yes No If yes, when?Have you ever been convicted of any law violation (except a minor traffic violation)? Yes No If yes, please give details:(A “Yes” answer does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying is also considered) Are you now or do you expect to be engaged in any other business or employment? Yes No If yes, please explain: EducationHigh School or GEDSchool NameSchool Address# of Years CompletedDiploma/Degree/CertificateCollege or UniversitySchool NameSchool AddressSubjects Studied# of Years CompletedDiploma/Degree/CertificateVocational or Technical SchoolSchool NameSchool AddressSubjects Studied# of Years CompletedDiploma/Degree/CertificateSpecial SkillsWhat additional training do you have that is related to the job for which you are applying?What machines or equipment can you operate that are related to the job for which you are applying?How many days of work have you missed in the past year?(Exclude absences due to disability or those covered by FMLA) List professional, trade, business, or civic activities and offices held.(Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability, or other protected statuses.)Do you have a valid driver’s license? Yes No The following questions are for Driving Jobs ONLYDriver’s License NumberClass of LicenseHave you ever had your driver’s license revoked in the last 3 years? Yes No If yes, give details: Work HistoryList names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed give firm name and supply business references.Employment History Name of Employer Position Title Actions Edit Delete There are no Employers. Add Employer Maximum number of employers reached. Upload Your ResumeUpload your resume in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 25 MB. ReferencesGive three references, not relatives or former employers.Reference #1 NameReference #1 AddressReference #1 PhoneReference #2 NameReference #2 AddressReference #2 PhoneReference #3 NameReference #3 AddressReference #3 PhoneHave you worked or attended school under any other names? Yes No If yes, give names:Are you presently employed? Yes No If yes, may we contact them and whom do you suggest we contact?Have you ever been fired from a job or asked to resign? Yes No If yes, please explain: AFFIDAVIT - PLEASE READ EACH STATEMENT CAREFULLY(Required) I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I understand that the employer may request an investigative consumer report from a consumer reporting agency. This report may include information as to my character, reputation, personal characteristics and mode of living obtained from interviews with neighbors, friends, former employers, schools, and others. I understand I have a right to make a written request within a reasonable time for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required. I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE. I have read, understand, and by checking this box and submitting this application I consent to these statements. A signature or electronic signature by the parent or legal guardian is also required if the applicant is under sixteen (16) years of age. Electronic SignaturePlease type your full name below to serve as your electronic signature.Parent or Legal Guardian SignatureRequired for applicants under 18. Please ask your Parent or Legal Guardian to compete the line below Electronic Signature of Parent or Legal GuardianPlease type your full name below to serve as your electronic signature.Once submitted, this application for employment will remain active for six (6) months. Request for Criminal Background CheckName First Middle Last Suffix Maiden Name/Alias Name First Middle Last Suffix Sex Male Female Race African American Caucasian Native American Asian Other Date of Birth Month Day Year SSNAddress Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Purpose for request: Employment Licensing Other If other, please specify:Certification of true and complete application details.I hereby certify that all statements made on or in connection with this application are true and complete to the best of my knowledge and belief. I understand and agree that any mis-statements or omission of material facts will cause forfeiture on my part to all rights of employment or revocation of license by the City of Warrenton. I have read and agree to the statement above.Authorization for Criminal Record SearchI hereby authorize the City of Warrenton Police Department to make a search to see whether or not I have any record of arrest and/or convictions anywhere in the United States, and that information can be given to the Director of Operations, Human Resources, Licensing personnel, as well as the Mayor of the City of Warrenton to become part of my file. I have read and agree to the statement above.Photo static of Xerox copy of this authorization shall be considered as effective as the original. THIS AUTHORIZATION, APPLICATION, AND ALL DOCUMENTS SUBMITTED BECOME THE PROPERTY OF THE CITY OF WARRENTON AND WILL NOT BE RETURNED. Electronic SignaturePlease type your full name below to serve as your electronic signature for this Request for Criminal Record Search. Required DocumentsTHE FOLLOWING COPIES MUST BE SUBMITTED WITH YOUR COMPLETED APPLICATION VALID DRIVERS LICENSE CERTIFICATE OF POST CERTIFICATION ACCREDITED LAW ENFORCEMENT ACADEMY CERTIFICATE HIGH SCHOOL DIPLOMA OR GED Drivers LicenseAccepted file types: pdf, png, jpeg, jpg, Max. file size: 25 MB. Certificate of Post CertificationAccepted file types: pdf, png, jpeg, jpg, Max. file size: 25 MB. High School Diploma or GEDAccepted file types: pdf, png, jpeg, jpg, Max. file size: 25 MB. Accredited Law Enforcement Academy CertificateAccepted file types: pdf, png, jpeg, jpg, Max. file size: 25 MB.
