City of Washington - Application for Employment

Applicant Information
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Title of position for which you are applying:*
Are you a U.S. citizen or otherwise authorized to work in the U.S.?*

YesNo
What kind of work will you accept?*

Full-TimePart-Time
Driver’s License #*
Class*
State*
Have you had any traffic violations in the past 3 years?*

NoYes
If yes, list charges and dates:*
Have you been convicted of a crime?*

YesNo
If yes, give details including date, place, charges, and disposition. (Omitnon-moving traffic violations and any offense that was adjudicated in a Juvenile Court or under a Youth Offender Law.)*
NOTE: A conviction will not necessarily bar you from employment. Each case is judged on its own merits with respect to time,circumstances, and severity. Failure to disclose a conviction will result in disqualification.

Military Service
Branch*
From*

MonthDayYear
Date
To*

MonthDayYear
Date
Rank at Discharge*
Type of Discharge*
If other than honorable discharge, please explain:*
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature*
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
File Upload*

Cancelof
Please verify that you are human*
Should be Empty:

Applicant Information