Youth Services Manager Application
Thank you for applying for employment with the City of Platteville. Complete the entire application, including signature and date, to ensure consideration. The City of Platteville does not discriminate based on race, color, religion, national origin, creed, age, marital status, sex, sexual orientation or disability. Applicants are not required to reveal any information that may identify these attributes.
Applicant Information
Applicant Name
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First Name
Middle Name
Last Name
Street Address
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Apartment/Unit #
City
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State
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ZIP
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Phone
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Please enter a valid phone number.
Format: (000) 000-0000.
E-mail Address
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example@example.com
Date Available
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Desired Salary
Are you a citizen of the United States?
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Yes
No
If no, are you authorized to work in the U.S.?
Yes
No
Have you ever worked for the City of Platteville?
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Yes
No
If so, when?
Have you ever been convicted of a felony?
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Yes
No
If yes, explain
Have you ever been convicted of a misdemeanor crime of domestic violence?
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Yes
No
If yes, explain:
Are you prohibited by state or federal law from possessing a firearm?
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Yes
No
If yes, explain:
Are you related to any current City of Platteville employee or elected official?
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Yes
No
If yes, who?
Do you possess a valid Wisconsin driver’s license or a valid driver’s license from another state?
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Yes
No
If yes, which state?
Cover Letter
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Resume
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Upload Resume
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Professional References: Please provide three professional references. For each reference, include their full name, title, organization, phone number and/or email address, and relationship to you.
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Applicant Certification Signature:
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• I certify that the information provided in this application (and accompanying resume, if any) is true, correct and complete to the best of my knowledge without omissions of any kind. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. • I authorize persons, schools, my current employer (if applicable) and previous employers and organizations named in this application (and accompanying resume, if any) to provide any relevant information to the City of Platteville that may be required to enable the City of Platteville to arrive at an employment decision. • I release the City of Platteville and all providers of information from any liability and a result of furnishing and receiving any information related to the City of Platteville’s hiring process. • I understand that I may be required to submit to a pre-employment physical examination, including substance abuse screening, prior to appointment. I agree that the results of such examinations and screening may be released to the City of Platteville only for the consideration of my employment.• I further understand that any appointment or job offer tendered to me will be contingent upon the results of additional testing, a complete check and fitness evaluation. • I understand this application for employment will be considered active for up to 45 days. If I still want to be considered for employment thereafter, I will need to inquire as to whether or not applications are being accepted. • I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the City of Platteville is of an “at will” nature, which means that as an “at will” employee, I may resign at any time and that the City of Platteville may discharge me at any time with, or without cause. • I understand that if hired, I am required to abide by all rules and regulations of the City of Platteville
Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Optional: Confidentiality Request
Under Wisconsin State Statutes, the names of applicants must be revealed unless a request for confidentiality is received from the applicant. If you wish to keep your name confidential to the extent allowed by the Wisconsin Statutes, you need to sign the request below. Please understand that should you become a finalist for employment and a request is made, Wisconsin Statutes require us to release your name. I request that my employment application and all related references and documents remain confidential to the extent allowed by Wisconsin Statutes since they would tend to reveal my identity.
Confidentiality Request Signature
Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Application
Submit Application
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