APPLICATION FOR EMPLOYMENT

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status. The City of Bainbridge is an equal opportunity Employer.

Position(s) Applied For  

Date of Application  

Name (Last, First, Middle Initial)  

Address (include City, State Zip)

Telephone Number  

Social Security Number  

Best time to contact you at home  

If you are under 18 years of age, can you provide required proof of your eligibility to work?
Yes   No  

Have you ever filed an application with us before?
Yes   No  

If yes, please provide at date  

Have you ever been employed with us before?
Yes   No  

If yes, give date  

Do any of your friends or relatives, other than spouse, work here?
Yes   No  

Are you currently employed?
Yes   No  

May we contact your employer?
Yes   No  

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status (proof of citizenship or immigration status will be required upon employment)?
Yes   No  

Date available for work  

What is your desired salary range?  

Are you available to work Full-Time?
Yes   No  

If yes, which shift (1, 2, or 3)?  

Are you available to work Part-Time?
Yes   No  

If yes, please indicate Mornings, Afternoons, or Evenings  

Are you currently on "lay-off" status or subject to recall?
Yes   No  

Can you travel if a job requires it?
Yes   No  

Name Elementary School attended (include address with City, State Zip)

Years of Elementary Education (please answer from 1 to 9)  

Did you receive a Diploma or Degree?
Yes   No  

Name High School attended (include address with City, State Zip)

Years of High School Education (please answer from 1 to 5)  

Did you receive a Diploma or Degree?
Yes   No  

Name College or University attended (include address with City, State Zip)

Years of College or University Education (please answer from 1 to 5)  

Did you receive a Diploma or Degree?
Yes   No  

Name Graduate or Professional School attended (include address with City, State Zip)

Years of Graduate or Professional Education (please answer from 1 to 4)  

Did you receive a Diploma or Degree?
Yes   No  

Name Any Other School attended (include address with City, State Zip)

Years of Other Education (please answer from 1 to 5)  

Did you receive a Diploma or Degree?
Yes   No  

Describe any specialized training, apprenticeship, skills, and extra-curricular activities.

Describe any job-related training received in the United States military

Employment Experience

1. Employer (include City, State Zip)

Employer's Telephone Number  

Job Title  

Supervisor  

Date Range of Employment  

Hourly Wage Range during employment (Beginning -- Ending)  

Briefly describe the work performed

Reason for leaving

2. Employer (include City, State Zip)

Employer's Telephone Number  

Job Title  

Supervisor  

Date Range of Employment  

Hourly Wage Range during employment (Beginning -- Ending)  

Briefly describe the work performed

Reason for leaving

3. Employer (include City, State Zip)

Employer's Telephone Number  

Job Title  

Supervisor  

Date Range of Employment  

Hourly Wage Range during employment (Beginning -- Ending)  

Briefly describe the work performed

Reason for leaving

4. Employer (include City, State Zip)

Employer's Telephone Number  

Job Title  

Supervisor  

Date Range of Employment  

Hourly Wage Range during employment (Beginning -- Ending)  

Briefly describe the work performed

Reason for leaving

List professional, trade, business, or civic activities and offices held. (You may exclude memberships which would reveal gender, race, religion, national origin, age, ancestry, diability, or other protected status)

Other qualifications: Summarize special job-related skills and qualifications acquired from employment or other experience

Specialized Skills
Terminal   PC/MAC   Typewriter   Spreadsheet   Word Processing   Shorthand   Production/Mobile Machinery   Other  

State any additional information you feel may be helpful to us in considering your application

NOTE TO APPLICANTS: Do not answer this question unless you have been informed about the requirements of the job for which you are applying. Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?
Yes   No  

A review of the activities involved in such a job or occupation have been provided to me.
True   False  

Reference #1 (include Name, Address, and Phone Number)

Reference #2 (include Name, Address, and Phone Number)

Reference #3 (include Name, Address, and Phone Number)

Applicant's Statement: I certify that answers given herein are true and complete. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. Signature:(type in all capital letters to electronically sign)  

Date  

Email Address of Applicant (REQUIRED)