Job Application
Please complete the form below to apply for a position with us.
Position Applied For:
*
Full Name
*
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
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Day
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Year
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
example@example.com
Phone Number
*
Do you have a drivers license? (If required for the position for which you are applying)
Yes
No
Have you ever been discharged or forced to resign from a job?
*
Yes
No
Were you previously employed by the City of South Charleston?
*
Yes
No
If yes, please explain.
Will you accept?
*
Part time work
Full time work
Shift work
Temporary work
Military Service
*
None
Yes
Branch
Rank
Serial Number
Date
Type of Discharge
Have you ever been convicted of a misdemeanor or felony?
*
Yes
No
Conviction is not a bar to employment. If so, what was it?
Are you legally authorized to work in the US on a full time basis?
*
Yes
No
Available Start Date
/
Month
/
Day
Year
Is there anything which would prevent you from performing the essential functions of the job for which you are applying?
*
Yes
No
If yes, give details.
Education
Name of School
Years Attended
Graduated?
High School
College
Graduate or Trade School
Other
What are your plans (if any) for improving your education?
Describe academic honors, awards, scholarships, etc.
Describe special skills or abilities.
Typing Speed
Dictation Speed
List memberships in professional organizations.
Employment History
List work experience, beginning with your present or most recent job. Describe each job separately. Give special attention to experience relating to the job you are applying for. Incomplete descriptions may result in a lower rating.
Employing Firm
Address
Your Title
Number Supervised
Supervisor
Duties
Date Employed
From:
blanks
to
blank
.
Full time
Part time
Starting Salary
Last Salary
Reason for wanting to leave.
Additional Experience.
References
Do not list relatives or former employers.
Name
Home Address
Phone
Years Known
1
2
3
Additional Information. Use this space for additional comments or explanations as necessary.
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of
I hereby certify that the answers given by me to the foregoing questions and statements made by me are true to the best of my knowledge. I understand that any false statement or misrepresentation of facts included in this application or supplements thereto is cause for rejection of my application or discharge after my employment.
Signature
*
Date
*
-
Month
-
Day
Year
Date
I understand that I am applying for a position as an employee-at-will. I understand that, if hired, my employment will be for no definite period of time, that will be an employee-at-will, that I will be free to leave employment with the city at any time and for any reason and that the city may terminate my employment at any time with or without cause and with or without notice. I understand that nothing in the city's written policies, handbooks, or other documents may be construed as creating any contractual obligations on the part of the city. Furthermore, I understand that no one at the city is authorized to make any contract relating to my employment unless the contract is set forth in writing and signed by the mayor of the city.
I voluntarily authorize the city to obtain information from any employers or references listed.
I voluntarily authorize
to give information regarding me and I hereby release said persons from any liability or claim whatsoever for issuing this information.
Signature
Date
-
Month
-
Day
Year
Date
I voluntarily authorize the city to obtain information from any employers or references listed.
I voluntarily authorize
to give information regarding me and I hereby release said persons from any liability or claim whatsoever for issuing this information.
Signature
Date
-
Month
-
Day
Year
Date
I voluntarily authorize the city to obtain information from any employers or references listed.
I voluntarily authorize
to give information regarding me and I hereby release said persons from any liability or claim whatsoever for issuing this information.
Signature
Date
-
Month
-
Day
Year
Date
Apply
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