CITY OF BELGRADE EMPLOYMENT APPLICATION (CONT.)

Employment Application

·  Please complete this application by typing or printing in ink. INCOMPLETE or UNSIGNED applications will not be considered.

·  Prior to submitting your application materials, please refer to the job announcement to ensure all application materials are included. Failure to include the required documents will be considered an incomplete application.

·  The City of Belgrade is an equal opportunity employer. We do not discriminate on the basis on race, color, religion, national origin, creed, service in the uniformed services (as defined by state and federal law), veteran’s status, sex, age, political ideas, marital or family status, pregnancy, physical or mental disability and genetic information.

POSITION APPLYING FOR: ____

PERSONAL INFORMATION
Last Name / First Name / Middle / Date of Application
Street Address / City / State / Zip
Phone / Message Phone / Email Address
Driver’s License Number & State / Endorsements
______Operator CDL - type:
EDUCATIONAL AND TRAINING INFORMATION
Please include any education or training relative to the position you are applying for, including military experience. Attach additional pages if needed.
Colleges, Vocational or Technical Schools, Training Centers / Major Subject / Units / Type of Degree or Certificate / Date
LICENSES AND CERTIFICATES REQUIRED FOR, OR RELATED TO, THIS POSITION
Description / Issued by / ID # / Expiration Date

Please list, at a minimum, the last 10 years of your employment. Attach additional pages if necessary in the same format. Completing this portion of the application is required information, submitting a resume in place of this section will be considered an incomplete application.

WORK EXPERIENCE (list most recent position first)
Name of current or most recent employer / Address – City – State - Zip
Starting date / Ending Date / Hours per week / Reason for leaving
Month/Year / Month/Year
Job title (present or most recent) Salary / Supervisor’s Name / Phone
Job duties
May we contact this employer? YES NO
Name of employer / Address – City – State - Zip
Starting date / Ending Date / Hours per week / Reason for leaving
Month/Year / Month/Year
Job title (present or most recent) Salary / Supervisor’s Name / Phone
Job duties
May we contact this employer? YES NO
Name of employer / Address - City – State - Zip
Starting date / Ending Date / Hours per week / Reason for leaving
Month/Year / Month/Year
Job title (present or most recent) Salary / Supervisor’s Name / Phone
Job duties
May we contact this employer? YES NO
Name of employer / Address – City – State -Zip
Starting date / Ending Date / Hours per week / Reason for leaving
Month/Year / Month/Year
Job title (present or most recent) Salary / Supervisor’s Name / Phone
Job duties
May we contact this employer? YES NO
Name of employer / Address – City – State – Zip
Starting date / Ending Date / Hours per week / Reason for leaving
Month/Year / Month/Year
Job title (present or most recent) Salary / Supervisor’s Name / Phone
Job duties
May we contact this employer? YES NO
PROFESSIONAL REFERENCES
Name: / Relationship:
Phone: / Email:
Name: / Relationship:
Phone: / Email:
Name: / Relationship:
Phone: / Email:

The information that you provide on this application is subject to verification. Falsifications or misrepresentations may disqualify you from consideration for employment or, if hired, may be grounds for termination at a later date.

An offer of employment is conditional upon successful completion of a pre-employment background check. Credit checks may be required if position includes a financial component.

Applicants will be responsible for their own travel expenses if invited for an interview with the City of Belgrade.

·  Do you need an accommodation to participate in the application or interview process? YES NO

·  Are you claiming an employment preference for this application? YES NO If yes, what type of preference?

Veterans Disabled Veteran Other: If other, please list:

Disability If you are claiming a disability employment preference please complete the following information (§§ 39-30-206 MCA):

How long have you lived in Gallatin County?

How long have you lived in the State of Montana?

·  Do you want to be informed before we contact your present employer? Yes No

With my signature below (typed or written), I certify that all information on this and all attached pages is true, correct and complete to the best of my knowledge and contains no willful falsifications or misrepresentations. I authorize all former employers to release job-related information they may have about me and I release all persons or companies from any liability or responsibility for providing such information.

SIGNATURE / DATE

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