Employment Application

Part TitleStep 1 of 1

Position applying for (only list one choice) *

Postion Type

Full-Time
Part-Time
Temporary
Seasonal

When are you available to start?

Minimum Acceptable Pay Rate

Will you work weekend overtime if necessary?

Will you work overtime during the work week if necessary?

PERSONAL DATA

First Name *

Middle Name *

Last Name *

Email *

Cell Phone *

Are you 18 years of age or older? *

Current Address *

Address Line 1

City

State / Province / Region

Zip / Postal Code

How long have you lived here? *

Previous Address *

Address Line 1

City

State / Province / Region

Zip / Postal Code

How long did you live here? *

CURRENT AND PREVIOUS EMPLOYMENT

Please list the names of your present and previous employers in chronological order with present or last employer listed first. Include part-time, seasonal and all other employment. If self-employed, give company name and supply business references. If you need more space submit as an extra attachment. DO NOT ANSWER SEE REUME! Fill out the form completely.

Employer Name *

Employer Phone *

Supervisor Name and Title *

Employer Address *

Address Line 1

City

State / Province / Region

Zip / Postal Code

Your Job Tile *

Dates Employed From/To *

Work Performed *

Reason for Leaving *

Starting Salary *

Ending Salary *

Were you ever disciplined? *

If so, for what?

Employer Name

Employer Phone

Supervisor Name and Title

Employer Address

Address Line 1

City

State / Province / Region

Zip / Postal Code

Your Job Title

Dates Employed From/To

Work Performed

Reason for Leaving

Starting Salary

Ending Salary

Were you ever disciplined?

If so, for what?

Employer Name

Employer Phone

Supervisor Name and Title

Employer Address

Address Line 1

City

State / Province / Region

Zip / Postal Code

Your Job Tile

Dates Employed From/To

Work Performed

Reason for Leaving

Starting Salary

Ending Salary

Were you ever disciplined?

If so, for what?

Employer Name

Employer Phone

Supervisor Name and Title

Employer Address

Address Line 1

City

State / Province / Region

Zip / Postal Code

Your Job Tile

Dates Employed From/To

Work Performed

Reason for Leaving

Starting Salary

Ending Salary

Were you ever disciplined?

If so, for what?

BACKGROUND INFORMATION

EDUCATION

High School Highest Year Completed

High School Name and Location

Major or Course of Study Focus

Activities / Training / Skills

College/University Highest Year Completed

College/University Name and Location

Major or Course of Study Focus

Activities / Training / Skills

Graduate/Professional Highest Year Completed

Graduate/Professional Name and Location

Major or Course of Study Focus

Activities / Training / Skills

Graduate/Professional Highest Year Completed

Trade/Correspondence Name and Location

Major or Course of Study Focus

Activities / Training / Skills

Do you have a G.E.D. Certificate?

OTHER INFORMATION

List any applicable professional or occupational registration, licensure or certification you have..

Please provide any other relevant information or qualifications you have.

Please describe your immediate and long term career goals.

CRIMINAL HISTORY

Prior to conducting a background investigation, we will provide you with a release form that complies with the Fair Credit Reporting Act and any applicable state law. DO NOT INCLUDE any information about arrests or convictions that were sealed, eradicated, erased, annulled or expunged, or convictions that resulted in the referral to a diversion program. DO NOT DISCLOSE a conviction that a court granted you First-Time Offender Status.

Have you ever pled no contest, nolo contendere or guilty to a misdemeanor crime, or been convected of a misdemeanor crime? *

If yes, give dates and details for each incident.

Note: Answering YES does not constitute an automatic bar to employment. The city will consider the nature of the crime, its seriousness, the substantial relation to the position's functions and qualifications, the number of occurrences, the applicant's age at the time of the crime, the time elapsed since the crime, the applicant's entire work and educational history, employment references and recommendations and the business necessity of any exclusion when required by law.

Have you ever pled no contest, nolo contendere, or guilty to a felony crime or been convicted of a felony crime? *

If yes, give dates and details for each incident.

DRIVING INFORMATION

Complete only if driving is an essential function of the job that you are applying for.

REFERENCES

Please provide three work and two personal references.

Work Reference: Name *

Title *

Company *

Phone *

Work Reference: Name *

Title *

Company *

Phone *

Work Reference: Name *

Title *

Company *

Phone *

Personal Reference: Name *

Relationship *

Phone *

Personal Reference: Name *

Relationship *

Phone *

Please attach your resume, cover letter and any other support documents.

Drop your file here or click here to upload You can upload up to 5 files.

Applicant's Signature *

DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THESE STATEMENTS: I understand that the City of Carrollton is committed to providing equal opportunity in all employment practices, including but not limited to selection, hiring, assignment, re-assignment, promotion, transfer, compensation, discipline, and termination to all qualified applicants and employees without regard to race, color, religion, genetic information, national origin, sex, pregnancy, childbirth, or related medical conditions, age, disability or handicap, citizenship status, service member status, or any other category protected by federal, state, or local law. I authorize former and present employers, and professional, work, and personal references listed in the application or interview process and any other individuals I may name, to give the City or its designee any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release such parties from all liability for any damages that may result from furnishing same to the City. I also authorize the City to provide truthful information concerning my employment (if any) with it to future employers or as may be required, and I agree to hold it harmless for providing such information. I understand that the City reserves the right, to the extent permitted by applicable law, to require drug and alcohol screening tests of an applicant or an employee either prior to employment or any time during employment and I hereby give my consent to any such tests. I consent to the release of the results of any such tests to the City or its designees. I release the City and its designees from any and all liability and damages that may result or arise from any drug test or the provision of information in connection with such a test. Testing, if any, will only occur in accordance with applicable legal requirements. I understand that this employment application and any other City documents are not promises of employment. Should I be employed, I understand that my employment will be on a trial period initially and that I will remain an at-will employee thereafter. I further understand that, if I am employed, I can terminate my employment at any time with or without cause and with or without advance notice and that the City has a similar right. I understand that no manager, representative, or agent of the City has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, except that the City of Carrollton City Manager may do so in writing. In the event of my employment with the City, I will comply with all rules and regulations of the City. I certify that the information given by me on this application and during the interview process is and will be true and complete in all respects, and I agree that if the information is found to be false, misleading, or unsatisfactory in any respect (in the City’s judgment) that I will be disqualified from consideration for employment or subject to immediate termination if discovered after I am hired. I certify that I understand the City may obtain “consumer reports” (for example, criminal history,driving records, etc.) on me for use in connection with my application and, if I am hired, my employment. This application will be considered

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