Employment Application Form

Application for Employment

Dawson Public Safety Department
NOTICE TO APPLICANTS: Please be aware that all statements and information submitted are subject to investigation. This application must be completed in your own handwriting and must be complete.

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED FOR HIRE.

You will need to supply the following documentation
1. Valid Driver’s License
2. Copy of your Social Security Card

If requested you will need to supply the following:
1. Copy of your High School Diploma or GED
2. Copy of your Birth Certificate
3. Copy of your DD214 (Military Discharge)
Date

MonthDayYear
Date
Seeking Position With:*

PoliceFireCommunication
Seeking:*

Full-timePart-time
Personal Information
1. Name:*

First NameMiddle InitialLast NameSuffix
2. Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
3. Phone #*

Area CodePhone Number
Alternate Contact #

Area CodePhone Number
4. Social Security #*
Date of Birth*

MonthDayYear
5. Do you have a valid driver's License?*
Issuing State*
6. Driver License #*
7. Are you a U.S. Citizen?*
8. Have you ever been arrested or charged in ANY court for ANY violation of Federal, State or Local Ordinance? (NOTE: This includes traffic violations)*
If YES please explain:
9. Have you ever been charged with a crime of Domestic Family Violence?*
If YES please explain:
10. Are you currently employed?*
If yes, where?
Name of Employer
11. May we Contact this Employer?*
If yes, what is the number?
Name of Employer
12. Have you ever applied with us before?*
If yes, when?
Name of Employer
13. Have you ever been employed by City of Dawson?*
If yes, when?
Name of Employer
What Department?
Reason for leaving?
14. Are you a member of any Military Reserve or National Guard Unit?*
If YES please explain:
15. Are you a Veteran of any branch of the U.S. Military?*
Branch of Service:
Date of Service:
Type of Discharge:
Highest Rank:
Rank at Discharge:
Describe any job training you had in the military:
16. Do you have any friends or relative who are employees of the City of Dawson? *

If YES, please list name and department:

	Name	Department
1
2
3

17. Please give name and contact information for three people who ARE NOT relatives or past employers orofficiate or employers or officiate or employees of the City of Dawson:*

	Name	Phone Number
1
2
3

18. Describe any specialized training, apprenticeship, skills, or extra-curricular activities that you feel might helpyou in the position you are seeking:
19. List any professional, trade, business, or civic activities you are involved in and any offices held. You may exclude anymembership which would reveal gender, race, religion, nationality, origin, age, ancestry, disability, or other protected status
20. Do you have a High School Diploma or GED?*
Issue Date:
21. Name of High School or Adult Education Center:
22. College attended and how long:
23. Other formal education:
Employment Experience:

Starting with your recent employer list all the jobs held in the last 5 years. Include jobs related to military service.
24. Employer:
Address:
Contact Name:
Supervisor's Name:
Primary Duties:
Reason for leaving:
25. Employer:
Address:
Contact Name:
Supervisor's Name:
Primary Duties:
Reason for leaving:
26. Employer:
Address:
Contact Name:
Supervisor's Name:
Primary Duties:
27. List any additional information you feel will be helpful to us in considering your application for employmentwith this department
28. Date available for employment:*
29. Are you available for shift work?*
30. Are you available for overnight travel or training?*
31. Email*
example@example.com
By submitting this application you certify that all information is true and correct. Any falsehood found will automatically disqualify you from consideration for employment
Should be Empty:

Application for Employment

Personal Information

Employment Experience:

By submitting this application you certify that all information is true and correct. Any falsehood found will automatically disqualify you from consideration for employment