NBR - Application for Employment

Application for Employment

An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, sexual orientation, marital status, genetic information or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on back of application. 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 Applied For blanks* Date* *

Are you seeking:*

Full-TimePart-TimeSeasonal

Name*

Home Phone Number

Email Address

Cell Phone Number

Address*

Previously employed by City of Lamar?*

YesNo

If Yes, when and where?

If hired, when would you be able to start?*

If employed, do you expect to be engaged in any additional business or employment outside of our job?*

YesNo

If yes, give details

Employment History

Please give accurate, complete full-time and part-time employment record. Start with the current or most recent employer. Show unemployment or self-employed periods, indicate dates of each and explain. All time must accurately and truthfully be accounted for. DO NOT PUT “SEE RESUME”. YOU NEED NOT EXPLAIN ANY GAPS IN EMPLOYMENT RELATED TO A DISABILITY OR REHABILITATION. Please attach a separate page if you need to add to this section.

POSITION 1

POSITION 2

POSITION 3

EDUCATION

Indicate education or training which pertains to the job for which you are applying. Include a list of current or completed list of certificates or degrees.

List Name and Address

JOB ABILITIES

Indicate job skills, education, training or equipment you can operate which pertains to the job for which you are applying. Include a list of current professional licenses, certificates or degrees.

Please list three references, not relatives or former employers.*

If required in the job for which you are applying:

Do you have a valid driver's license?

YesNo

Can you furnish proof?

YesNo

TO THE APPLICANT

Have you ever been fired or asked to resign?*

YesNo

If yes, explain in full

Are you presently employed?*

YesNo

RESUME, COVER LETTER, & SUPPLEMENTAL DOCUMENTS

Upload a Cover Letter if applicable:

Choose File(s)

Please include only Word, Text or PDF files.

Upload a Resume if applicable:

Choose File(s)

Please include only Word, Text or PDF files.

Upload supplemental documents as required in job posting (check back to job listing for additional requirements):

Choose File(s)

Please include only Word, Text, PNG, or PDF files.

IMPORTANT TO READ AND SIGN

AFFIDAVIT,CONSENT AND RELEASE

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

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 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 if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. 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 REASON AND WITH OR WITHOUT NOTICE.

This application for employment will remain active ONLY FOR THE POSTION APPLIED and must be signed by applicant to be given consideration. Please contact the City of Lamar’s Human Resource Department for details at 719-336-1366. Please return this application by the advertised deadline, no late applications will be accepted.

I have read and agree to the above statements*

I agree

Electronic Signature of Applicant*

First NameLast Name

General