City of Scottsboro

City of Scottsboro

Online Application
Voluntary Employment Inquiry

We are an equal opportunity employer. All information provided will be considered without regard to race, color, religion, creed, gender, age, marital status, political affiliation, national origin, or disibilities which do not affect the individuals ability to perform the essential functions of the position held or applied for with or without reasonable accommodation.
Name*

First NameLast Name
Position Sought*
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Email Address*
example@example.com
SeasonalTemporaryPart TimeFull Time
Hours or shift you're available.
Days you're available.
Education Info
High School
Undergraduate College
Graduate College
G.E.D
Major / Minor in College
Do you have a valid Drivers License?
What is your Drivers License #?
Do you have a valid CDL License?
Class of CDL?
Additional Competencies / Job Related Education Information
References
Reference #1
Reference Name #1

First NameLast Name
Phone Number

Area CodePhone Number
Reference #1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference #2
Reference #2 Name

First NameLast Name
Phone Number

Area CodePhone Number
Reference #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please list any Relatives employed by the City of Scottsboro.
Employment Experience
Employer Name
Your Job Title
Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
Employer Phone Number
Supervisor Name
Reason for Leaving
Work Performed
Start Date
End Date
Starting Pay
Ending Pay
Employer Name
Your Job Title
Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
Employer Phone Number
Supervisor Name
Reason for Leaving
Work Performed
Start Date
End Date
Starting Pay
Ending Pay
Employer Name
Your Job Title
Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
Employer Phone Number
Supervisor Name
Reason for Leaving
Work Performed
Start Date
End Date
Starting Pay
Ending Pay
Employer Name
Your Job Title
Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
Employer Phone Number
Supervisor Name
Reason for Leaving
Work Performed
Start Date
End Date
Starting Pay
Ending Pay

YesNo
YesNo
I understand that employment is subject to drug and alcohol testing and certify that all information provided is true and complete to the best of my knowledge. I authorize the City of Scottsboro to investigate the information provided and understand that false or misleading information given in this employment inquiry or subsequent interview(s) may result in dis-selection or discharge.
Name*

First NameLast Name
E-Signature*

Clear
Date

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