Parks & Recreation Employment Application - City of Story City

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Parks & Recreation Employment Application

Applicant Information

Name(Required)

First M.I. Last

Today's Date(Required)

Month

Day

Year

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Date Available(Required)

Month

Day

Year

Social Security Number

Desired Salary(Required)

Position Applying For(Required)

Was this position listed as Seasonal?(Required)

Yes

No

Unsure

Are you a citizen of the United States?(Required)

Yes

No

If no, are you authorized to work in the U.S.?(Required)

Yes

No

Have you ever worked for this company?(Required)

Yes

No

If yes, when?(Required)

Have you ever been convicted of a felony?(Required)

Yes

No

If you have been convicted of a felony, please explain:(Required)

Education

High School(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From:(Required)

Month

Day

Year

To:(Required)

Month

Day

Year

Did you graduate?(Required)

Yes

No

Diploma:(Required)

College

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From:

Month

Day

Year

To:

Month

Day

Year

Did you graduate?

Yes

No

Degree

Other

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From:

Month

Day

Year

To:

Month

Day

Year

Did you graduate?

Yes

No

Degree

References

Please list three professional references

Name

First Last

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Previous Employment

Company

Phone

Supervisor

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Month

Day

Year

To

Month

Day

Year

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Company

Phone

Supervisor

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Month

Day

Year

To

Month

Day

Year

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Company

Phone

Supervisor

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Month

Day

Year

To

Month

Day

Year

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Military Service

Branch

From

Month

Day

Year

To

Month

Day

Year

Rank at Discharge

Type of Discharge

If other than honorable, explain:

Disclaimer & Signature

Disclaimer(Required)

I understand

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Name

First Last

By entering your name in this field, you agree to electronically sign this document.

Today's Date

Month

Day

Year

Δ

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504 Broad St. Story City, IA

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