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APPLICATION FOR EMPLOYMENT City of POB 71 478-552-2525 Internet Address: Sandersville.net INCOMPLETE APPLICATIONS MAY BE REJECTED RESUMES ARE NOT ACCEPTED IN LIEU OF A COMPLETED APPLICATION ALL INFORMATION ON THIS APPLICATION MUST BE COMPLETE SO THAT ALL APPLICATIONS CAN BE GIVEN EQUITABLE CONSIDERATION. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT REGARDLESS OF RACE, COLOR, RELIGION, SEX, AGE, NATIONAL ORIGION, DISABILITY OR ANY OTHER FACTORS . THIS APPLICATION MUST BE TYPED OR PRINTED. YOU MUST SIGN AND DATE YOUR APPLICATION IN INK.
Other Names you have been employed under____________________________________________ Mailing Address___________________________________________________________________ Residence address_________________________________________________________________ E-mail address____________________________________________________________________ Land Line Telephone___________________Cell_________________Work___________________ Social Security Number__________________________Salary Requirement__________________ Will you accept full time_________________________Part Time________________________ Are you over 18 years old?______Are you eligible to work in the United States either because you are a U.S. Citizen or have U.S. government permission to do so? Yes__________No___________ (If offered employment you will be required to provide documentation to verify employment eligibility. Failure to provide the requested documentation may result in a determination that the applicant is ineligible for employment in the Have you been previously employed by the City of Give name, relationship and Department of any relatives employed by the City of Do you have a valid Drivers Permit: Yes___No____Number_______________________State____ List any traffic violations you have received in the last 3 years: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ CRIMINAL HISTORY INFORMATION Have you (since the age of 18) ever been convicted of or plead guilty or no contest to a misdemeanor? (DUI, Bad Checks, etc) Yes___No___ If YES describe the circumstances. (Date, Place, Charges, Disposition. Use additional sheets of paper if necessary. (Omit non-moving traffic violations/parking tickets and any offense which was finally adjudicated in a Juvenile Court or under a Youth Offender Law) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Have you (since the age of 18) ever been convicted of or plead guilty to no contest to a felony?Yes___No___ If Yes, describe the Circumstances: (Date, Place, Charges, Disposition) Use additional sheets if necessary. NOTE: Applicants convicted of a criminal offense involving the manufacture, distribution, tracking, or sale of a controlled substance, dangerous drugs or marijuana, or convicted of any felony involving a violent crime such as assault with a deadly weapon, aggravated assault or murder are ineligible to be employed with the City of Have you ever been suspended, demoted, dismissed or asked to resign from any job? Yes___ No___ If YES explain in detail ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ EDUCATION HIGH SCHOOL NAME & LOCATION ________________________________________________________________________________Graduated? Yes___No___Highest Grade completed ________If NO, Do you have a GED or equivalent? Yes___No____ COLLEGES/ UNIVERSITIES
Describe specialized training, skills or extra curricular activities which would relate to the position for which you are applying. Include computer skills and programs, office equipment, etc. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ REFERENCES: Please give 3 references that ARE NOT RELATED TO YOU AND ARE NOT PREVIOUS EMPLOYERS: Name __________________________________________________Phone#___________________ Street Address____________________________________________________________________ City, State Zip____________________________________________________________________ Name __________________________________________________Phone#___________________ Street Address____________________________________________________________________ City, State Zip____________________________________________________________________ Name __________________________________________________Phone#___________________ Street Address____________________________________________________________________ City, State Zip____________________________________________________________________ EMPLOYMENT HISTORY Begin with your most recent job and include military and volunteer experience and periods of unemployment. Failure to give complete information regarding each job held may result in your disqualification. Complete addresses with zip codes and telephone numbers are necessary. A resume may be attached only as additional information and will not be accepted in lieu of completing this section. Use additional sheets if necessary. Name of Business_________________________________________Telephone#_______________ Address_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Dates Employed___________________________________________________________________ Name of Supervisor________________________________________________________________ Your Job Title____________________________Duties___________________________________ Specific Reason for Leaving_________________________________________________________ Name of Business_________________________________________Telephone#_______________ Address_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Dates Employed___________________________________________________________________ Name of Supervisor________________________________________________________________ Your Job Title____________________________Duties___________________________________ Specific Reason for Leaving_________________________________________________________ Name of Business_________________________________________Telephone#_______________ Address_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Dates Employed___________________________________________________________________ Name of Supervisor________________________________________________________________ Your Job Title____________________________Duties___________________________________ Specific Reason for Leaving_ ________________________________________________________ Name of Business_________________________________________Telephone#_______________ Address_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Dates Employed___________________________________________________________________ Name of Supervisor________________________________________________________________ Your Job Title____________________________Duties___________________________________ Specific Reason for Leaving_________________________________________________________ AUTHORIZATION TO RELEASE INFORMATON CONDITIONS OF EMPLOYMENT I have made application for employment with the City of Furthermore, if I am employed by the City of Sandersville, I agree to the policies, rules, orders and regulations of the government set forth in the City of Sandersville ?s Personnel system, policies and procedures and ordinances; and acknowledge that these policies and procedures, rules, and regulations may be changed, interpreted, withdrawn, or added to by the City of Sandersville at any time, at the City?s sole option. I further acknowledge that if I become employed with the City of Sandersville, my employment will be at -will and may be terminated with or without cause at any time by me or the City of Sandersville until such time that I am no longer on my initial trial period, and become a regular status employee. I consent to undergo a physical examination and I understand the offer of employment by the City of THIS APPLICATION WILL REMAIN ACTIVE FOR NINETY (90) DAYS. Are you presently employed? YES___NO___ May we contact your present employer? YES___NO___ You must sign the ?Authorization to Release Information? form to enable us to contact prior employers, even though we may not contact your present employer. Print your name___________________________________________________________________ Signature________________________________________________________________________ Date______________________ |
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