Date of Application: Position for Which Applying:______
DATE OF APPLICATION: POSITION FOR WHICH APPLYING:______
CITY OF MUSTANG
APPLICATION FOR EMPLOYMENT
AN EQUAL OPPORTUNITY EMPLOYER: The City does not discriminate on the basis of race, color, religion, sex, national origin, age, marital, political affiliation, genetic status, handicapped status, or any other legally protected status.
IF YOU NEED ASSISTANCE IN COMPLETING THIS APPLICATION FORM OR IN PARTICIPATING IN THE SELECTION PROCESS, PLEASE INFORM THE HUMAN RESOURCES DEPARTMENT.
Print or write answers to each question clearly and completely. All questions must be answered. This is an application for employment and no employment contract is being offered.
Last name First Middle Last Four Digits of
Social Security Number
Address City StateZip Code
______
Home Phone NumberCell Phone NumberEmail Address
List any other name(s) you have been known by:
Date available for work: Are you at least 16 years of age? Yes or No
Are you available to work: weekends nights
At this point, please stop and review the job description for which you are applying. After reviewing the essential job functions, the minimum qualifications, and the special requirements from the job posting or job description, are you able to do them with or without reasonable accommodation? Yes No
The City is concerned with your ability to perform the job and will not at this time, consider your need for reasonable accommodation except as necessary to complete the application form. If after reviewing your application form, verifying your responses, conducting an extensive background investigation, conducting necessary interviews or tests, you are considered for the job and would need reasonable accommodation to perform the essential job functions, the parties will explore these alternatives.
Warning: All information in this application will remain confidential and only released according to law or by signed waiver; however, it will be subject to extensive background examination. Any false, misleading, or incomplete statements will be considered grounds for rejection. Leave no blank spaces. If the question does not apply to you, mark N/A (not applicable).
As you complete the next portions, provide us with prior education, work experience, and any relevant training or certificates and licenses that would indicate your knowledge, skills, and abilities to perform the job.
1. Are you a U.S. citizen? Yes No.
Are you legally eligible to work in the United States? Yes No
2. Have you ever worked for the City of Mustang? If yes, give prior name and dates and reason for leaving:
______
3. Are you related to any City employee or member of the City Council? If so, give name, department, and relationship.
4. Have you applied with the City of Mustang previously? ___ If so when?
5. Do you know any City of Mustang employees? If yes who?
6. Have you been convicted of a felony or are you currently charged with the commission of a felony? If yes,
state what, when and how:
7. Education: List highschool(s), college(s), correspondence, business or technical schools attended. Exclude military schools.
Location Type of Hours Graduate/
Name of SchoolCity and StateSchoolCompletedDegree
Do you possess a high school diploma or G.E.D. equivalent? Yes No
8.List all special educational honors, scholarships, etc., received.
9. List all memberships in school societies, fraternities, or clubs (exclude membership in organizations indicating national origin).
10. Employment experience for the past 10 years. Beginning with your current or most recent position, list all employment, including part time (attach additional sheets if necessary).
A. Dates (from-to)
Employed by (name of firm)
(address)
Name of SupervisorPhone number
Position TitleSalary
Types of Duties
Reason for Leaving
B. Dates (from-to)
Employed by (name of firm)
(address)
Name of SupervisorPhone number
Position TitleSalary
Types of Duties
Reason for Leaving
C. Dates (from-to)
Employed by (name of firm)
(address)
Name of SupervisorPhone number
Position TitleSalary
Types of Duties
Reason for Leaving
D. Dates (from-to)
Employed by (name of firm)
(address)
Name of SupervisorPhone number
Position TitleSalary
Types of Duties
Reason for Leaving
*****
IF YOU ARE EMPLOYED NOW, MAY WE CONTACT YOUR PRESENT EMPLOYER?YES NO
11. Which of your previous jobs did you like the most?
Explain the duties and reasons why:
12. Which of your previous jobs did you like the least?
Explain the duties and reasons why:
Give the name, address and telephone number of three references that are not related to you and are not previous employers.
Name Address Telephone Number(s)
Name Address Telephone Numbers(s)
Name Address Telephone Number(s)
Applicant Please Read Carefully Before Signing
I certify that the facts given in this application are true and complete to the best of my knowledge and I agree that information given that is found to be false in any way shall be considered sufficient reason for denial of employment or discharge. I authorize the use of any information in this application to verify my statements and, except as indicated above, I authorize the past employers, all references and any other persons to answer all questions asked concerning my ability, character, reputation and previous education or employment record. I release all such persons from any liability or damages on account of having furnished such information. I consent to such investigations as The City of Mustang may make regarding driving records, law enforcement records and my general background. I further understand that all applicable portions of this application must be completed or I will be ineligible for consideration for the position for which I am applying.
I understand that nothing contained in this employment application or in the granting of an interview or of a position of employment is intended to create an employment contract between The City of Mustang and myself for either employment or for the providing of any benefits. No promises regarding employment have been made to me, and I understand that no promise or guarantee of employment for any specific length of time or under any specified circumstances shall be binding upon The City of Mustang unless made in writing by or with the express written consent and authorization of the City Manager. If any employment relationship is established, I understand that I have the right to terminate my employment at any time and for any reason and that The City of Mustang retains the same right.
I understand that, if I am initially offered a position of employment, The City of Mustang may require me to pass a medical exam and/or drug screen prior to commencement of work and as a condition of employment. Refusal to submit to a drug screen shall be considered sufficient reason for denial of employment or discharge.
I understand that if employed, I agree to abide by the policies and rules which issued by The City of Mustang and that The City of Mustang may revise policies or procedures, in whole or in part, unilaterally at any time.
IMPORTANT: IF YOU DO NOT UNDERSTAND OR IF YOU DISAGREE WITH ANY PORTION OF THE ABOVE CERTIFICATION, DO NOT SIGN BEFORE DISCUSSING WITH A REPRESENTATIVE FROM THE CITY OF MUSTANG.
______
Applicant SignatureDate