Rincon, GA - Employment Application

City of Rincon Employment Application
Equal Employment Opportunity

Our company is an Equal Opportunity Employer. All qualified applicants will be considered for positions without regard to race, color, religion, gender, national origin, age, marital or veteran status, or the presence of a physical or mental disability that is not job-related. applicants are evaluated on the basis of ability, experience, and the requirements of the job. We will make reasonable efforts to accommodate physical or mental limitations of qualified applicants.

Please answer all questions thoroughly.
Application Date:

MonthDayYear
Date
Position you are seeking:
How did you hear about this position?
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Home:*
Phone Other:
E-mail:*
example@example.com
Expected Salary of Wage, $ per hour:
Date Available for Work:

MonthDayYear
Date

Desired Hours:

	Mon	Tue	Wed	Thu	Fri	Sat	Sun
Time

Available to Work Overtime?

YesNo
Type of Employment:

Full TimePart TimeTemporarySeasonalInternship/Volunteer
Are you able to be legally employed in the United States?

YesNo
Have you previously been employed with this company?

YesNo
If Yes, please provide the date of your employment and position:
Having friends or relatives at this company will not enhance or diminish your opportunity for employment
If hired, do you have a reliable means of transportation to work?

YesNo
If hired, would there be restrictions on travel if required?

YesNo
Have you ever been convicted of a felony?

YesNo
If Yes, please explain:
List all present and past employers, starting with your most recent employer
Employer 1
Employer:
Employer 1
Phone
Please enter a valid phone number.
Date employed from:

MonthDayYear
Date
Date employed to:

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState

Zip Code
Job title:
Immediate supervisor:
Reason for Leaving:
Describe Duties and Responsibilities:
Employer 2
Employer:
Employer 2
Phone
Please enter a valid phone number.
Date employed from:

MonthDayYear
Date
Date employed to:

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState

Zip Code
Job title:
Immediate supervisor:
Reason for Leaving:
Describe Duties and Responsibilities:
Employer 3
Employer:
Employer 3
Phone
Please enter a valid phone number.
Date employed from:

MonthDayYear
Date
Date employed to:

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState

Zip Code
Job title:
Immediate supervisor:
Reason for Leaving:
Describe Duties and Responsibilities:
Education and Training
High School
Name
City/State
Course of Study
Years Completed
Type of Degree
Undergraduate College
Name
City/State
Course of Study
Years Completed
Type of Degree
Graduate/Professional
Name
City/State
Course of Study
Years Completed
Type of Degree
Other
Name
City/State
Course of Study
Years Completed
Type of Degree
List any certification, training, or other education not listed above that may help you qualify for this position:
List below three persons not related to you who have knowledge of your work performance within the last 5 years
Person 1
Name

First NameLast Name
Occupation
Company
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Person 2
Name

First NameLast Name
Occupation
Company
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Person 3
Name

First NameLast Name
Occupation
Company
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState

Zip Code
May we contact your current employer?

YesNo
Please list any employer or person provided on this application that you do not authorize us to contact
Please read the following statements. Initial each paragraph and sign below.
I certify that the above information is accurate and true to the best of my knowledge. In the event of my employment, I understand and agree that false or misleading information given in my application or interview(s) may result in discharge. Initial: blanks

I understand that this application is for informational purposes only and does not constitute an offer of employment or an employment contract. If an employment relationship is later established, I understand my right to resign at anytime for any reason. I also understand that this company may also terminate my employment at any time, for any reason not prohibited by law. Initial:  Type a label

I authorize   Company name   to inquire and investigate into my employment, educational, professional, criminal and other background as needed to verify the information on this application and research my qualifications for this position. Unless specifically stated in this application, this company may contact all employers and references that I have provided in order to obtain this information. Initial:   Type a label

I hereby release   Company name   from all liability that might result from such investigations into my background. Initial:   Type a label

I understand that if I am offered a position with this company, I will be given a drug and alcohol test within 48 hours. I understand that negative test results are required as a condition of my employment, and that all test results will remain confidential. Initial:   Type a label

I hereby acknowledge that I have read and agree to the above statements.

Printed Name (First, Middle, Last)
Signature or Applicant      Date
Consent For Pre-Employment Reference & Background Checks
Instructions to Applicant:
1. Please read carefully before signing this authorization.
2. As a result of your request for employment consideration with our company, we intend to investigate into your background to verify the information you have provided us. Our inquiries will be limited to obtain only information that is job related and will be include reference checks, previous employment inquiries, and verification of your training and education.
3. Because of your right to privacy, this form is needed to allow former employers, business references, and educational institutions to provide us this information. This form will be mailed or faxed to these parties as verification that you have waived your right to privacy.
4. If you agree with these statements and the waiver provided below, please provide your signature and today's date at the bottom of this form.
Authorization and Waiver
I hereby authorize blanks and its agents to conduct an investigation of my application for employment.

I authorize and request any and all former employers, business references, and educational institutions to furnish (orally and/or in writing) information concerning my past job performance and my work, salary, and educational histories. I hereby release these parties and their representatives furnishing such information from any and all liability that may result from complying with this authorization.

I recognize that a photocopy or a facsimile of this original document is a valid requisition.
Signature of Applicant      Date
Type a label
Area Code   Phone Number
Should be Empty:

City of Rincon Employment Application

List all present and past employers, starting with your most recent employer

Education and Training

List below three persons not related to you who have knowledge of your work performance within the last 5 years

Please read the following statements. Initial each paragraph and sign below.

Consent For Pre-Employment Reference & Background Checks

Authorization and Waiver