Application for Employment

Full Name*

Current Street Address*

City*

State*

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Zip*

Mailing Address (if different from above)

City

State

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Zip

Telephone*

Alternate Phone

Social Security Number*

Drivers License*

Position for which you are applying*

How did you hear of this opening?*

Are you seeking full time employment?*

Yes

No

Of not, when are you available?

Can you work swing shift?*

Yes

No

Can you work the graveyard shift?*

Yes

No

Date available to begin work*

Desired Wage*

Are you a U.S. citizen or otherwise authorized to work in the U.S. on unrestricted basis?*

Yes

No

Have you ever been convicted of a crime?*

Yes

No

If yes, fully describe the circumstances

Education

High School*

Address*

City*

State

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Zip*

Degree/Achievements *

College

Address

City

State

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Zip

Degree/Achievements

Other

Address

City

State*

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Zip

Degree/Achievements

Any other additional skills, qualifications, or experience you would like us to consider?

**Please include any additional educational information on resume'

Employment History

Start with most recent

Company

Address

City

State*

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Zip

Date Started

Starting Wage

Starting Position

Date Ended

Ending Wage

Ending Position

Supervisor Name

May we contact?

Yes

No

Responsibilities

Reason for leaving

Company

Address

City

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip

Date Started

Starting Wage

Starting Position

Date Ended

Ending Wage

Ending Position

Supervisor Name

May we contact?

Yes

No

Responsibilities

Reason for leaving

**Please include any other previous employment information on resume'

Resume'

Attach copy of current resume'

Applicant Certification

I certify the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed by the City of Fredonia, false statements on this application shall be considered sufficient cause for dismissal. The City of Fredonia is hereby authorized to make investigation into my prior educational, employment, and criminal history. I understand that employment at the City of Fredonia is "at will" which means that I or the City can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute; employment will continue on that basis. I understand that no supervisor, manager, or administrator of the City of Fredonia has authority to alter the foregoing.

Signed*

Date*