Employment Application Form Employment Application Step 1 of 2 50% Your Personal InformationYour Name First Last Date of application MM slash DD slash YYYY Referral Source: Advertisement Employee Relative Government Employment Agency Walk-in Private Employment Agency Internet Web Site Other Your Email Address Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Telephone NumberMay we contact you at work? Yes No If yes, phone numberBest Time To Call YouWhen is the best time for us to reach you via telephone?MorningsEveningHave you filed an application here before? Yes No If yes, give date MM slash DD slash YYYY And position applied for Have you worked here before? Yes No If yes, give dates MM slash DD slash YYYY Are you legally eligible for employment in the country? Yes No Are you on layoff and subject to recall? Yes No Date available to work MM slash DD slash YYYY Are you able to meet the attendance requirements of the position? Yes No Will you work overtime if required? Yes No Have you ever been bonded? Yes No Do you have a valid driver's license (if job related)? Yes No Have you been convicted of a felony in the last seen (7) years? Yes No If yes, please explain Employment HistoryList your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in the comments section below. Your Current EmployerPlease list your previous employers, the dates you worked and the position you heldCurrent EmployerTelephoneAddress Add RemovejobJob TitleImmediate Supervisor & TitleReason For leavingMay we contact reference? Add RemovePrevious Job SpecificDates EmployedSalary StartingSalary Final Add RemoveYour Previous EmployersPlease list your previous employers, the dates you worked and the position you heldCurrent EmployerTelephoneAddress Add RemovejobJob TitleImmediate Supervisor & TitleReason For leavingMay we contact reference? Add RemovePrevious Job SpecificDates EmployedSalary StartingSalary Final Add RemoveYour Previous EmployersPlease list your previous employers, the dates you worked and the position you heldCurrent EmployerTelephoneAddress Add RemovejobJob TitleImmediate Supervisor & TitleReason For leavingMay we contact reference? Add RemovePrevious Job SpecificDates EmployedSalary StartingSalary Final Add RemoveYour Previous EmployersPlease list your previous employers, the dates you worked and the position you heldCurrent EmployerTelephoneAddress Add RemovejobJob TitleImmediate Supervisor & TitleReason For leavingMay we contact reference? Add RemovePrevious Job SpecificDates EmployedSalary StartingSalary Final Add RemoveEducational BackgroundA. List last three (3) schools attended, starting with most recent. B. List number of years completed. C. Indicate degree or diploma earned, if any. D & E. Major and minor field of study (if applicable). EducationPlease list your previous employers, the dates you worked and the position you heldSchoolYears CompletedDegree CompletedMajorMinor Add RemoveEducationPlease list your previous employers, the dates you worked and the position you heldSchoolYears CompletedDegree CompletedMajorMinor Add RemoveEducationPlease list your previous employers, the dates you worked and the position you heldSchoolYears CompletedDegree CompletedMajorMinor Add RemoveSkill and QualificationsReferencesList name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you. References (1)NameTelephoneYears Known Add RemoveReferences (2)NameTelephoneYears Known Add RemoveReferences (3)NameTelephoneYears Known Add RemoveOrganizations & Offices HeldList professional, trade, business, or civic associations and any offices held. (Exclude n memberships which would reveal gender, race, religion, national origin, age, color, disability or other protected status.) List special accomplishments, publications, awards, (exclude information which would reveal gender, race, religion, national origin, age, color, disability or other protected status.)List any additional information you would like us to consider.Upload Your ResumeUpload your resume in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 25 MB.Terms and Conditions(Required)It is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from the City of Genesee’s service if I have been employed. I give the City of Genesee the right to investigate all references and to secure additional information about me, if job-related. I hereby release from liability the City of Genesee and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. The City of Genesee is an Equal Opportunity Employer. The City of Genesee does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law. This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application. I understand it is the City’s policy not to refuse to hire a qualified individual because of this person’s need for an accommodation that would be required by the ADA. I agree to the terms and conditions.Signature of Applicant First Last Date MM slash DD slash YYYY Δ
