TOWN OF PARKER EMPLOYMENT APPLICATION

Town of Parker Employment Application

1314 11th Street Parker, AZ 85344 Phone (928) 669-9265 Fax (928) 669-9265
EQUAL OPPORTUNITY/REASONABLE ACCOMMODATION EMPLOYER

Anyone requiring assistance in completing the application form may request assistance from Human Resources.

The Town of Parker considers applicants for all positions without regard to the applicant's legally protected status, including, without limitation, the applicant's race, color, religion, creed, gender, national origin, tribal affiliation, age, disability, marital status, veteran status, or any other legally recognized basis under federal, state, or local law. Applicants with disabilities may be entitled to reasonable accommodation under the Americans with Disabilities Act and certain state or local laws. Please inform Human Resources if you need assistance completing this application or to otherwise participate in the application process.
(PLEASE TYPE OR PRINT LEGIBLY)
Position Applied For*
Date of Application*

MonthDayYear
Date
Name*

First NameMiddle Initial
Last Name
Address (Street, PO Box, City, State, Zip)*
Phone*
Email*
example@example.com
Valid Driver's License Number*
Issuing State*
All requested information must be furnished. The information you provide will determine whether you are eligible for the position or further examination process. All information contained in this application is subject to verification. Any omission, misstatement or falsification may be cause for rejection of this application, removal of your name from an eligibility list, or termination from Town service. Applications are accepted for review only when positions are open.
Are you under 18 years of age?

YesNo
If you are under 18 years of age can you provide required proof of your authorization to work?*
Have you ever filed an application with the Town of Parker before? If yes please provide date(s) *
Have you ever been employed with the Town of Parker? If yes, please provide date(s)*
Are you related to any Town of Parker employees?*
Are you currently employed?*
Have you ever been terminated or forced to resign due to misconduct or unsatisfactory service? If yes, please explain. *
If hired, can you furnish proof that you are eligible to work in the United States?*
Are you able to perform the "essential functions" of the job for which you are applying for with or without reasonable accomodations? *
Date available for work*

MonthDayYear
Date
Desired salary range*
Are you available to work full time, part time, or temporary? (Part time/temporary, please specify days/dates below)*
Are you currently on "lay-off" status or subject to recall If YES please explain:*
Since your 18th birthday, have you been convicted (found guilty, plead guilty, plead no contest) of any criminal offense? If yes, please explain *
A yes answer does not automatically disqualify you from employment because the nature of the offense, date, and type of job for which you are applying will be considered. The information you fill out will be verified, you must be truthful and honest. This includes any misdemeanors and felonies (i.e. assault, burglary, disorderly conduct, domestic violence, drug-related convictions, driving under the influence, driving while intoxicated, failure to appear in court, theft, shoplifting, trespassing, etc
EDUCATION, TRAINING, AND SKILLS
High School *
Under Graduate *
ADDITIONAL QUALIFICATIONS
List additional knowledge, skills, qualifications, publications, certificates, or awards that will be helpful in consideration of your application for employment
Typing words per minute
Shorthand words per minute
Computer Skills: List the computer/hardware/software programs with which you are proficient
PERSONAL OR PROFESSIONAL REFERENCES

PLEASE DO NOT INCLUDE FAMILY MEMBERS OR PAST SUPERVISORS
Reference 1: *
Name, Phone, Occupation
Reference 2: *
Name, Phone, Occupation
Reference 3: *
Name, Phone, Occupation
POLICE POSITIONS ONLY
Are you a citizen of the United States of America?
Are you 21 years of age or older?
Are you P.O.S.T. Certified?
EMPLOYMENT HISTORY

Show complete experience in each position beginning with your current or last position, including military and volunteer experience. A resume may be attached, but will not be accepted in lieu of completing the employment record. Be sure to list each significant change in title separately, even with the same employer.
CURRENT EMPLOYER
PHONE NUMBER
MAILING ADDRESS
JOB TITLE
STARTING/ENDING SALARY
SUPERVISOR
REASON FOR LEAVING
MAY WE CONTACT?
DATES EMPLOYED

MonthDayYear
Date
WORK PERFORMED
PREVIOUS EMPLOYER
PHONE NUMBER
MAILING ADDRESS
JOB TITLE
STARTING/ENDING SALARY
SUPERVISOR
REASON FOR LEAVING
MAY WE CONTACT?
DATES EMPLOYED

MonthDayYear
Date
WORK PERFORMED
PREVIOUS EMPLOYER
PHONE NUMBER
MAILING ADDRESS
JOB TITLE
STARTING/ENDING SALARY
SUPERVISOR
REASON FOR LEAVING
MAY WE CONTACT?
DATES EMPLOYED

MonthDayYear
Date
WORK PERFORMED
PREVIOUS EMPLOYER
PHONE NUMBER
MAILING ADDRESS
JOB TITLE
STARTING/ENDING SALARY
SUPERVISOR
REASON FOR LEAVING
MAY WE CONTACT?
DATES EMPLOYED

MonthDayYear
Date
WORK PERFORMED
ADDITONAL INFORMATION
Is any additional information relative to change of name or nickname necessary to enable a check on your work and education records?*
If YES please explain
If hired, will you be able to work during the normal days and hours required for the position? *
If NO please explain
Do you have any commitments to another employer that might affect your employment with the Town? *
If YES please explain
Do you have any experience from your military service that would be relevant to the job for which you are applying? *
If YES, please explain
Do you have any language abilities (such as reading or speaking a language other than English) that might help you perform the job for which you are applying?*
If YES, please explain
Selection Process
Applications will be reviewed and the most qualified applicants will be selected to be interviewed. An eligible list will be established from these interviews. If you are invited to a testing process and might require reasonable accommodation to participate, please advise the Human Resources Office at the time you are contacted. All applicants will be notified of their status by mail. The final selection will be made by the appropriate Department Head with the approval of the Town Manager. Every effort will be made to process your application in a timely manner. The selection process ensures a very thorough review of all applications to determine those who meet the minimum requirements for this position. Due to the large number of applications received, the review and response to applications require up to two weeks to complete.

If an applicant requires "Reasonable Accommodation" in the testing process, the applicant must submit a "Reasonable Accommodation Request Form" to the Human Resources Office after the job posting closing date and a minimum of 5 business days before the testing process begins. Applications must be signed and submitted to the Human Resources Office by 5:00 PM on the closing date. Town Policy allows the hiring of relatives of current Town employees in the same department as the currently employed relative. However, relatives may NOT work for the same immediate supervisor if the relatives are located in the same work area/office.

PRE-EMPLOYMENT REQUIREMENTS MAY INCLUDE:

1. Approval of employment by Department Head and Town Manager.

2. Passing of Drug Screen.

3. Passing a scheduled physical examination paid for by the Town of Parker.

4. Successful completion of background investigation.

5. Provide official verification as to identity and work authorization.
Applicant's Statement
Please read and initial each statement and sign below
By signing this application, I certify that the answers given herein are true and complete to the best of my knowledge, and any omissions or misstatements of facts may be cause for rejection of this application or discharge from Town Service.*
Initial here
I authorize the Town of Parker, or its designee, to make all necessary and appropriate investigations allowable by law of all statements contained in this application for employment, including but not limited to, a criminal history background check and fingerprinting check through local and federal law enforcement.*
Initial here
I understand that it is my responsibility to advise the Town of Parker about any changes of address, phone number, or other contact information.*
Initial here
I understand that this application for employment shall be considered active for a period of time not to exceed 90 days and I understand that if I wish to be considered for employment beyond this time period I should inquire as to whether or not applications are being accepted at that time.*
Initial here
I understand that if I am offered a position, as a condition of beginning my employment, I may be required to undergo a physical examination and drug screen, and I hereby authorize any doctor, hospital, clinic, laboratory, or other medical facility to furnish any medical information with reference to me as may be necessary in conjunction with that examination, and/or related considerations of reasonable accommodation, fitness for duty, or as required by law.*
Initial here
I understand that employment in a driving position is dependent upon a safe driving record, and authorize the Town of Parker to obtain an MVD report of my driving. *
Initial here
If hired, I agree to comply with current Town of Parker Rules and Regulations and accept that the Town Council may make changes/ amendments any rules, regulations, or benefits in the future during the course of my employment. Nothing in the Town of Parker Rules and Regulations implies a contract of employment for a particular period of time *
Initial here
If hired, I do hereby agree to submit to any and all required drug and/or alcohol testing (as per the Town's Substance Abuse Policy) and to have test results reported to the Town of Parker. I release the Town of Parker from all liability in obtaining information pursuant to this release.*
Initial here
If hired, I also agree to have my photograph taken for identification purposes.*
Initial here
I authorize the Town of Parker to contact my current and former employers (unless I have answered NO to "May we contact") and the schools and references I have identified on this application for the purpose of verifying the information I have provided. *
Initial here
I hereby release the Town of Parker including all employees, designees, from all liability as a result of inquiries based on information contained in my application or connected with the hiring process.*
Initial here
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Signature of Applicant*

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Date*

MonthDayYear
Date
Town of Parker - Employment Application - 04/2022
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Town of Parker Employment Application

(PLEASE TYPE OR PRINT LEGIBLY)

EDUCATION, TRAINING, AND SKILLS

ADDITIONAL QUALIFICATIONS

PERSONAL OR PROFESSIONAL REFERENCES

POLICE POSITIONS ONLY

EMPLOYMENT HISTORY

ADDITONAL INFORMATION

Selection Process

Applicant's Statement