APPLICATION FOR EMPLOYMENT         CITY OF YAMHILL

                                                                                                                                       P.O. BOX 9

                                                                                                                                        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
High School  or GED
Vocational, Tech, or Jr. College
College or University
Course of Study/Major
Other

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
Address
Job Title                                                       Supervisor	Hourly Rate/Salary Starting            Ending SSS
Reason For Leaving

Employer                                                      Telephone	Dates Employed From                  To		Work Performed
Address
Job Title                                                       Supervisor	Hourly Rate/Salary Starting             Ending
Reason For Leaving
Employer                                                      Telephone	Dates Employed From                  To		Work Performed
Address
Job Title                                                       Supervisor	Hourly Rate/Salary Starting              Ending
Reason For Leaving
Employer                                                      Telephone	Dates Employed From                  To		Work Performed
Address
Job Title                                                       Supervisor	Hourly Rate/Salary Starting              Ending
Reason For Leaving

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 United States.  If I cannot provide such proof in accordance with Federal Law, I understand that I will be terminated.

 

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 Yamhill to conduct and hold the City of Yamhill harmless from any result of the reference and background check that the City makes.  I hereby authorize and release from all and any liability whatsoever all former employers and their employees, educational institutions, law enforcement agencies, and/or other government agencies, who I hereby request to provide/release information to and candidly respond to any inquires of the City of Yamhill and its agents regarding my employment, character, job performance, ability, education, criminal and civil court/law enforcement records and motor vehicles records, that may be in their possession.

 

 

 

 

                                                             

Signature of Applicant                                                                             Date