9641 Bellefontaine Road
St. Louis County, MO 63137
314 / 867-0076
Fax: 314 / 867-1790
APPLICATION FOR EMPLOYMENT
If you need assistance completing this application, contact the City Clerk
APPLICANT NOTE: This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, creed, national origin, disability or any other legally protected status. Additional testing of job-related skills and for the presence of drugs in your body may be required for employment.
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Position Applied For:
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Date of Application
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How Did You Learn About Us?
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Friend
Walk-In
Employment Agency
Relative
Other
Other
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Name
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First Name
Middle Initial
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Telephone Number(s)
Format: (000) 000-0000.
Have you ever filed an application with us before?
Yes
No
If Yes, give date:
Have you ever been employed with us before?
Yes
No
If Yes, give date:
Are you currently employed?
Yes
No
May we contact your present employer?
Yes
No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Yes
No
Proof of citizenship or immigration status will be required upon employment.
On what date would you be available for work?
Are you available to work:
Full Time
Part Time
Shift Work
Temporary
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EMPLOYMENT EXPERIENCE
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disability or other protected status.
EMPLOYMENT EXPERIENCE
Rows
Employer
Address
Telephone Number(s)
Job Title / Supervisor
Reason for leaving
Employed From
Employed To
Salary Starting
Final Salary
Describe Work Performed
Employer 1
Employer 2
Employer 3
Employer 4
If the job requires, do you have the appropriate valid driver's license?
Yes
No
Driver's License No.
Type
State of Issue
Have you ever had any moving violations? If yes, please describe:
Have you had any job related training in the United States Military?
Yes
No
If yes, please describe
EDUCATION
EDUCATION
Rows
Elementary School
High School
Undergraduate College / University
Graduate / Professional
School Name and Location
Years Completed (4, 5, 6, 7, 8) Elementary
High School (9, 10,, 11, 12)
Undergraduate or Graduate
(1, 2, 3, 4)
Diploma/Degree
Course of Study
Describe any specialized training, apprenticeship, skills and extra-curricular activities that may be job related.
Describe any honors you have received.
State an additional information you feel may be helpful to us in considering your application.
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Describe any specialized training, apprenticeship, skills and extra-curricular activities that may be job related.
Describe any honors you have received.
State an additional information you feel may be helpful to us in considering your application.
REFERENCES
Give name, address and telephone number of three references who are not related to you and are not previous employers.
REFERENCES Give name, address and telephone number of three references who are not related to you and are not previous employers.
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Name
Address
Telephone Number
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2.
3.
APPLICANT STATEMENT
I certify that I have read and understand the Applicant Note on Page 1 of this form and that the answers given by me to the forgoing questions and the statements made by me are complete and true to the best of my knowledge and belief.
I understand that any false information, omission or misrepresentation of facts called for in this application may result in rejection of my application or discharge at any time during my employment.
I authorize investigation to verify any of this information including, but not limited to, previous employment history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information.
I also understand that the use of illegal drugs is prohibited during employment. If policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
I hereby understand and acknowledge my responsibility to notify the employer if I need reasonable accommodation in any testing procedures or interviews required as a result of submission of this application
I also understand that the use of illegal drugs is prohibited during employment. If policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
Signature of Applicant
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Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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FOR INTERNAL USE ONLY
Do not Complete
Arrange Interview
Yes
No
Remarks:
Employed
Yes
No
Date of Employment:
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Job Title:
Hourly Rate/Salary:
Department:
By:
Name and Title
Date:
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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