APPLICATION FOR EMPLOYMENT
P.O.
YAMHILL, OR 97148
Please Print or Type 503-662-3511
Position applied for ____________________________________________ Phone: _____________________
Name: _ Message Phone: ______________
Last First Middle
Work Phone: ______________
Mailing Address _________________________________________
Street May we contact you at work? _____ yes
_______________________________________________________ _____no
City State Zip
EDUCATION
Name and Location of School |
Dates From To |
Graduated Yes No |
Credit Hours Earned |
Type of Degree, Diploma, or Certificate |
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High School or GED |
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Vocational, Tech, or Jr. College |
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College or University |
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Course of Study/Major |
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Other |
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Honors received/state any additional information you feel may be helpful to us in considering your application: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
EMPLOYMENT HISTORY
Please complete this section even if you attach a resume. List your work experience, most recent first, during the past ten years. Include military and volunteer experience. Attach additional sheet if necessary.
Employer Telephone |
Dates Employed From To |
Work Performed |
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Address |
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Job Title Supervisor |
Hourly Rate/Salary Starting Ending SSS |
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Reason For Leaving
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Employer Telephone |
Dates Employed From To |
Work Performed |
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Address |
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Job Title Supervisor |
Hourly Rate/Salary Starting Ending |
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Employer Telephone |
Dates Employed From To |
Work Performed |
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Address |
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Job Title Supervisor |
Hourly Rate/Salary Starting Ending |
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Reason For Leaving |
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Employer Telephone |
Dates Employed From To |
Work Performed |
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Address |
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Job Title Supervisor |
Hourly Rate/Salary Starting Ending |
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Reason For Leaving |
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REFERENCES
List the names of three persons other than former employers and relatives having knowledge of your character, experience, or ability.
NAME |
ADDRESS |
RELATIONSHIP |
PHONE |
Have you ever been convicted of a felony? Yes No (circle one)
(Please exclude cases processed in the juvenile court or expunged convictions.)
Conviction does not necessarily disqualify your from employment.
RELEASE OF INFORMATION
I understand that this application does not represent a contract of employment. I also understand that if I am employed by the City of Yamhill, my employment can be terminated with or without cause during my probationary period or seasonal/temporary status of employment and thereafter in accord with City policy which may be revised by the City periodically.
I affirm that each answer to the questions incorporated into this application and all other information otherwise furnished by me is and shall be true, complete, and correct. I understand that falsification, misrepresentation or omission of information on my application may result in disqualification of my application, or dismissal from employment if I am employed. I also understand that failure to sign the application form below may disqualify me from the employment selection process. Within not more than three (3) days of employment, I will provide proof as required on the US Government, I-9 Form that I am legally eligible for employment in the
I understand that criminal and civil court/law enforcement records, motor vehicle driving records, education verification and reference checks will be conducted on final candidates prior to an offer of employment.
I have read and understand that by signing this application, I authorize the City of
Signature of Applicant Date