|
|
|
|
|
|
|
|
|
|
|
|
|
APPLICATION FOR EMPLOYMENT |
|
CITY OF PASS CHRISTIAN &nbs=
p;
P.O. BOX 368 &nbs=
p; &=
nbsp; &nbs=
p;
PASS CHRISTIAN, MS 39571 |
LAST_________________________
FIRST_____________________ MI________ |
|
|
PRE=
-EMPLOYMENT
QUESTIONAIRE; AN EQUAL OPPORTUNITY EMPLOYER |
|
|
|
|
|
| PERS=
ONAL
INFORMATION |
NAME: (LAST)
| |
(FIRST) |
|
(MI) |
|
SSN:=
|
| PRESENT
ADDRESS: |
|
|
CITY |
|
|
STATE |
ZIP |
|
| PERMANENT
ADDRESS: |
|
|
CITY |
|
|
STATE |
ZIP |
|
| PHONE: |
|
CELL=
: |
|
|
|
|
|
| DESI=
RED
EMPLOYMENT |
POSITION: |
|
|
DATE YOU CAN START: |
|
SALARY DESIRED: |
|
| ARE YOU EMPLOYED NOW? |
IF SO, MAY WE CONTACT YOUR PRESENT EMPLOYER? |
| HAVE YOU EVER APPLIED FOR EMPLOYMENT WITH
THE CITY OF PASS CHRISTIAN?
WHEN? WHAT DEPARTMEN=
T? |
| IF SO, WHEN DID YOU START? |
WHEN DID YOU LEAVE? |
|
SUPE=
RVISOR'S
NAME? |
| REASON
FOR LEAVING? |
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
| WHO REFERRED YOU TO US? |
|
|
|
|
|
|
|
|
|
|
|
|
|
| EDUC=
ATION |
SCHOOL LEVEL |
NAME AND LOCATIO=
N OF
SCHOOL |
YEARS ATTENDED |
|
DID YOU=
GRADUATE? |
SUBJECTS STUDIED=
: |
|
| GRAMMER=
SCHOOL |
|
|
|
|
|
|
| HIGH SC=
HOOL |
|
|
|
|
|
|
| COLLEGE=
|
|
|
|
|
|
|
| TRADE,
BUSINESS, OR CORRESPONDENCE SCHOOL |
|
|
|
|
|
|
| OTHER COLLEGE OR SCHOOL |
|
|
|
|
|
|
|
|
|
|
|
| GENE=
RAL |
SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK:=
|
|
|
|
|
|
|
| SPECIAL=
TRAINING: |
|
|
|
|
|
|
|
|
| SPECIAL =
SKILLS: |
|
|
|
|
|
|
|
|
| OTHER:
| |
|
|
|
|
|
|
|
| &nbs=
p; |
|
|
|
|
|
|
|
|
|
|
| &nbs=
p; |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
------=_NextPart_01C8BFE5.49ACDA60
Content-Location: file:///C:/576D8E50/CITYAPP_files/sheet002.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
|
|
|
|
|
|
|
|
|
|
|
| <=
/td>
| |
|
NAME:____________________________ |
|
|
LIST THE NAMES OF THREE PERSONS TO WHOM YOU=
ARE NOT
RELATED THAT YOU HAVE KNOWN AT LEAST ONE YEAR: |
| REFE=
RENCES |
NAME |
ADDRESS |
OCCUPATION |
YEARS ACQUAINTED=
|
| |
|
|
|
|
|
|
|
|
|
| &nb=
sp; |
|
|
|
|
|
|
|
|
|
| &nbs=
p; |
|
|
|
|
|
|
|
|
|
| LIST T=
HE NAMES OF
THREE RELATIVES |
| NAME
| ADDRESS |
OCCUPATION |
HOW RELATED |
| |
|
|
|
|
|
|
|
|
|
| &nb=
sp; |
|
|
|
|
|
|
|
|
|
| &nbs=
p; |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| SERV=
ICE RECORD |
|
|
|
| BRANCH O=
F SERVICE: |
ARE YOU CURRENTLY=
ENLISTED? |
| RANK/RAT=
E AT
DISCHARGE: |
TYPE OF DISCHARGE=
: |
| DUTIES W=
HILE ON
ACTIVE DUTY/RESERVE: |
|
|
|
|
|
|
| &nb=
sp; |
|
|
|
|
|
|
|
|
|
| OTHER TR=
AINING,
SCHOOLS, OR KSA'S THAT APPLY TO THIS JOB: |
|
|
|
|
| &n=
bsp; |
|
|
|
|
|
|
|
|
|
|
|
| LEGAL=
|
HAVE YOU BEEN CO=
NVICTED OF
A FELONY WITHIN THE LAST 5 YEARS? &nbs=
p;
YES / NO |
|
| IF
YES, PLEASE EXPLAIN. (WILL NOT NECESSARILY EXCLUDE YOU FROM CONSIDERATION=
): |
|
| |
|
|
|
|
|
|
|
|
|
| TRAFFIC
TICKETS? EXPLAIN: |
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
| <=
/td>
|
|
| |
|
| AUTH=
ORIZATION |
I CERTIFY THAT THE FACTS CONTAINED IN THIS
APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND |
| I UND=
ERSTAND
THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROU=
NDS
FOR DISMISSAL. |
|
| I AUT=
HORIZE THE
INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES AND
EMPLOYERS LISTED |
| ABOVE=
TO GIVE YOU
ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINE=
NT
INFORMATION |
| THEY =
MAY HAVE,
PERSONAL OR OTHERWISE AND RELEASE THE CITY OF PASS CHRISTIAN FROM ALL
LIABILITY FOR ANY |
| DAMAG=
E THAT MAY
RESULT FROM UTILIZATION OF SUCH INFORMATION. |
|
| I ALS=
O UNDERSTAND
AND AGREE THAT NO REPRESENTATIVE OF THE CITY OF PASS CHRISTIAN HAS ANY
AUTHORITY TO ENTER |
| INTO =
ANY
AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, NOR TO MAKE ANY
AGREEMENT CONTRARY |
| TO THE FOREGOING, UNLESS IT IS IN
WRITING AND SIGNED BY AN AUTHORIZED CITY REPRESENTATIVE. |
|
|
|
|
|
|
|
|
|
|
|
|
|
SIGNATURE |
|
DATE |
| <=
/td>
|
| <=
/td>
|
| <=
/td>
|
| <=
/td>
|
| <=
/td>
|
| <=
/td>
|
| <=
/td>
|
|
|
|
|
|
|
|
|
|
|
|
------=_NextPart_01C8BFE5.49ACDA60
Content-Location: file:///C:/576D8E50/CITYAPP_files/sheet004.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"