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CITY OF WEBSTER CITY EMPLOYMENT APPLICATION
Personal Information
Date
*
MM slash DD slash YYYY
Name
*
First
Middle
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
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Afghanistan
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Virgin Islands, U.S.
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Country
Social Security Number (no dashes)
*
Telephone
*
Email
Are you eligible for employment in the USA?
*
Yes
No
State age (if under 18)
Have you been convicted of a felony?
*
Yes
No
Employment Desired
Position Applying For
*
Where you previously employed by the City of Webster City?
Yes
No
If yes, when?
Rate of expected pay
If your application is considered favorably, on what date will you be available for work?
MM slash DD slash YYYY
Education
High School
Name & Location of School
No of Years Attended
Have you Graduated?
College
Name & Location of School
No of Years Attended
Have you Graduated?
Trade, Business, Correspondence School
Name & Location of School
No of Years Attended
Have you Graduated?
Military Service Record
If you were in the US Armed Forces, please complete the following:
I hereby give permission to contact the employers listed above concerning any information you deem relevant.
*
Yes
No
Branch
Rank at Discharge:
Former Employers
List below the last three employers, starting with the last one first)
#1 - Name and Address of Employer
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Starting Date (Month/Year)
MM slash DD slash YYYY
Ending Date (Month/Year)
MM slash DD slash YYYY
Salary
Positions/Duties
Reason for Leaving
#2 - Name and Address of Employer
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Starting Date (Month/Year)
MM slash DD slash YYYY
Ending Date (Month/Year)
MM slash DD slash YYYY
Salary
Positions/Duties
Reason for Leaving
#3- Name and Address of Employer
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Starting Date (Month/Year)
MM slash DD slash YYYY
Ending Date (Month/Year)
MM slash DD slash YYYY
Salary
Positions/Duties
Reason for Leaving
Is there a particular employer(s), you do not wish us to contact, please indicate which one(s).
Miscellaneous Information
Describe any skills, training or experience which especially qualifies you for the position for which you are applying.
Upload a copy of your resume, if available.
Accepted file types: pdf, Max. file size: 64 MB.
Please read and sign below
The facts set forth in my application for employment are true and complete. I understand if employed, any false statements on this application may result in my dismissal. I further understand that this application is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me.
Signature (type your name below)
*
35876
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