city of fort oglethorpe employment application

City of Fort Oglethorpe

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Application for Employment

APPLICATION FOR EMPLOYMENT

An Equal Opportunity EmployerWe do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any otherstatus protected by law or regulation. It is our intention that all qualified applicants be given equal opportunityand that selection decisions be based on job-related factors.

Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on back of application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Job Applied for:_____________________________________________________________ Today’s Date: ________________________

Are you seeking: Full-time Part-time Temporary employment? When could you start work? ______________

_____________________________________________________________________________ _______________________ Last Name First Name Middle Name Telephone Number

________________________________________________________________________________________________________ Present Street Address City State Zip Code

No (If you are hired, you may be required to submit proof of age.)

Yes No If yes, when? __________________________________________Have you ever applied here before?

Have you ever been employed here? Yes No If yes, when? __________________________________________

If employed, do you expect to be engaged in any additional businessor employment outside of our job?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If yes, give details ___________________________________________________________________________________________

Do you have a valid driver’s license? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Driver’s License Number _______________________________ Class of License_______ State Licensed In ___________

Have you had your driver’s license suspended or revoked in the last 3 years? . . . . . . . . . . . . . . . Yes No

If yes, give details: ____________________________________________________________________________________

List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.):

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Number of YearsCompleted

Diploma/DegreeCertificateLIST NAME AND ADDRESS OF SCHOOLS Subjects Studied

High School or GED:_________________________________________________________________________________________________

College or University: ________________________________________________________________________________________________

Vocational or Technical: _____________________________________________________________________________________________

What skills or additional training do you have that relate to the job for which you are applying? ____________________________

____________________________________________________________________________________________________________________

What machines or equipment can you operate that relate to the job for which you are applying?____________________________

____________________________________________________________________________________________________________________

Are you less than 18 years of age? . . . . . . . . . . . . . . . . . . . . . . . . . Yes

(answer not required unless the position requires driving a city vehicle)

E-Mail Address:________________________________

Rev. 10.23.19 Page 1 of 5

List all residences for the past ten (10) years, beginning with the most recent, including college and/or military residences.

Dates: From Dates: To Street Address/Apartment No. City Zip Code

List names of employers in consecutive order for the past ten (10) years with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Note: A job offer may be contingent upon acceptable references from current and former employers.

NAME OF EMPLOYER JOB TITLE AND DUTIES

ADDRESS DATES OF EMPLOYMENT (MO/YR)

CITY, STATE, ZIP CODEPAY: START $ FINAL $

SUPERVISOR(S) TELEPHONE Reason For Leaving


ADDRESS


SUPERVISOR(S) TELEPHONE REASON FOR LEAVING


ADDRESS




ADDRESS



Have you worked or attended school under any other names? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If yes, give names: _________________________________________________________________________________________

Are you presently employed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

FROM: TO:

DATES OF EMPLOYMENT (MO/YR)FROM: TO:



If yes, whom do you suggest we contact? ____________________________________________________________________

Have you ever been fired from a job or asked to resign? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If yes, please explain: _______________________________________________________________________________________

Give three (3) references, not relatives or former employers.

N Name Address Phone

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

State

Rev. 10.23.19 Page 2 of 5

Have you ever served on active duty in the U.S. armed forces? . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If yes, which branch: ______________________________________________________________________________________

Are you currently a member of active reserves or National Guard? . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If yes, which branch/status: _________________________________________________________________________________

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand that, in compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States, and will be required to complete an employment eligibility verification form upon being hired.

I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required.

I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I understand that all appointments are probationary for a period of one (1) year, during which time I must demonstrate my fitness for continued employment.

I understand that this application will be considered active for job vacancies which occur only during the next sixty (60) days. If I wish to be considered for job vacancies occurring after that period of time, I must resubmit my application.

I understand that certain non-privileged information supplied by me in this employment application and Consents for Release of Information, may be subject to public review under the Georgia Open Records Act, OCGA §50-18-70, et seq., or the Federal Freedom of Information Act, 5 USC § 552, et seq.

I hereby certify that all statements made by me on this application are true and complete to the best of my knowledge. I authorize the City of Fort Oglethorpe to investigate my previous work performance and to confirm any knowledge, skills and abilities required to qualify me for the position(s) I have indicated on this application.

I have read, understand, and by my signature consent to these statements.

Signature: _____________________________________________________ Date: _________________________________

List any additional employment, job-related skills, abilities, training or experience that may qualify you for a position:

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Rev. 10.23.19 Page 3 of 5

Authorization to Release Criminal History

I hereby authorize the City of Fort Oglethorpe Personnel Department or other authorized representative of the City of Fort Oglethorpe bearing this release or copy thereof, to obtain any information in my files pertaining to my criminal history.

This release is executed with full knowledge and understanding that the information is for official use of the City of Fort Oglethorpe Personnel Department.

Consent is granted for the City of Fort Oglethorpe to furnish such information as described above, to third parties in the course of fulfilling its official responsibilities.

Full Name: __________________________________________________________________(please print)

Driver's License Number: ___________________________ State of Issue: _______________

Height: _________ Weight: _________Race: _________ Sex: _________Eye Color: _________ Hair Color: _________

Signature: _________________________________ Date: ___________________

Notary: ___________________________________

Date of Birth: ___________________ SSN: ____________________________

Rev. 10.23.19 Page 4 of 5

Authorization to Release Information on Driving History

I hereby authorize the City of Fort Oglethorpe Personnel Department or other authorized representative of the City of Fort Oglethorpe bearing this release or copy thereof, to obtain any information in my files pertaining to my driving record.

This release is executed with full knowledge and understanding that the information is for official use of the City of Fort Oglethorpe Personnel Department.

Consent is granted for the City of Fort Oglethorpe to furnish such information as described above, to third parties in the course of fulfilling its official responsibilities. This form shall be valid over the course of my employment or volunteer services while authorized to drive vehicles owned by the City of Fort Oglethorpe.

Full Name: __________________________________________________________________(please print)

Driver's License Number: ___________________________ State of Issue: _______________

Signature: _________________________________ Date: ___________________

Notary: ___________________________________

Rev. 10.23.19 Page 5 of 5

city of fort oglethorpe employment application

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