EMPLOYMENT APPLICATION

EMPLOYMENT DESIRED
Date you can start*

MonthDayYear
Date
Hourly rate/Salary desired
Position desired*
Are you currently employed?*
If so may we inquire of your present employer
REFERRAL SOURCE
YesNo
YesNo
If yes who?

EDUCATION
High School (include name and location of school, highest level completed/degree received, and subjects studied/Major)*
College or University (include name and location of school, highest level completed/degree received, and subjects studied/Major)
Trade, Business, or Correspondence School (include name and location of school, highest level completed/degree received, and subjects studied/Major)

EMPLOYMENT HISTORY
Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.
From
To
Employer Name
Telephone
Address
Job Title
Immediate supervisor and title
Summarize the nature of work performed and job responsibilities
Reason for Leaving
From
Job Title
To
Address
Employer
Telephone
Immediate supervisor and title
Reason for Leaving
Summarize the nature of work performed and job responsibilities
From
To
Address
Employer
Telephone
Job Title
Immediate supervisor and title
Reason for leaving
Summarize the nature of work performed and job responsibilities
Do you have any special skills experience and/or training that would enhance your ability to perform the position applied for If yes explain

REFERENCES

Please provide the names of three persons not related to you whom you have know at least three years:
Reference 1*
include Name, Contact Information, Company (if applicable) and Years Acquainted
Reference 2
include Name, Contact Information, Company (if applicable) and Years Acquainted
Reference 3
include Name, Contact Information, Company (if applicable) and Years Acquainted
Please read carefully before signing. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the Village of Minerva Park to hire me. I understand that successful applicants will be required to undergo and pass a criminal background check, and drug screen. I further understand that my application may be rejected if I decline to sign this acknowledgement, decline to be drug tested, or if I do not pass the background check and drug screen. I understand that employment at the Village of Minerva Park is on an "at will" basis, and includes no guarantee, contract, or promise of employment for any specific length of time. I attest with my signature below that I have given to the Village of Minerva Park true and complete information on this application. No requested information has been concealed. I authorize the Village of Minerva Park to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

VILLAGE OF MINERVA PARK

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

EMPLOYMENT DESIRED

REFERRAL SOURCE

REFERENCES