City of Stanton Employment Application

City of Stanton P. O. Box 370 ** Phone 756-3301 Stanton, Texas 79782 Permanent, Full Time Temporary or Part Time Date of Application POSITION APPLYING FOR: APPLICANT PLEASE READ: Please print in ink or use typewriter. All information submitted is subject to verification. A false or misleading response may result in disqualification for employment or discharge, if employed. This application will not be accepted or considered until all questions are answered completely, and the application is signed. IDENTITY: FULL NAME: (LAST) (FIRST) (MIDDLE) PHONE: OPTIONAL PHONE: ADDRESS: (STREET) (CITY) (STATE) (ZIP) List your last four jobs (or ten years of work experience), including MILITARY and volunteer work. Begin with your current or most recent job and work back. LAST OR CURRENT EMPLOYER: Starting Date: Mo. Yr. Mailing Address: Ending Date: Mo. Yr. Name of Supervisor: Starting Salary: Per Your Position: Ending Salary: Per Reason for Leaving: May we contact this employer? Your Duties: NEXT

PREVIOUS EMPLOYER: Starting Date: Mo. Yr. Mailing Address: Ending Date: Mo. Yr. Name of Supervisor: Starting Salary: Per Your Position: Ending Salary: Per Reason for Leaving: May we contact this employer? Your Duties: NEXT PREVIOUS EMPLOYER: Starting Date: Mo. Yr. Mailing Address: Ending Date: Mo. Yr. Name of Supervisor: Starting Salary: Per Your Position: Ending Salary: Per Reason for Leaving: May we contact this employer? Your Duties: Please explain in detail any time lapses in the above record due to unemployment or other reasons: DRIVING RECORD: Do you have a valid Texas Driver’s License ? Driver’s License Number Type: Operator: Commercial: Chauffeur: Any restrictions: Have you driven commercially? If yes, how long? How many automobile accidents? How many while on the job? Have you ever had your license suspended or revoked? If yes, when? Why? For how long? EDUCATION: CIRCLE HIGHEST GRADE COMPLETED Grade School High School College Graduate School 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 1 2 3 KIND NAME AND LOCATION OF SCHOOL FROM MO. YR. TO MO. YR. GRADUATE (CIRCLE) DEGREE & MAJOR HIGH SCHOOL YES NO COLLEGE OR UNIVERSITY YES NO OTHER SCHOOLS ATTENDED YES NO In the space below, list additional training, educational seminars or short courses completed. Do you have a G.E.D. or equivalent? Yes No Year G.E.D. received: Place: SKILLS AND CERTIFICATION: LIST ALL VALID PROFESSIONAL LICENSE, REGISTRATIONS AND CERTIFICATES YOU PRESENTLY HOLD Type: Number: Expiration Date: Type: Number: Expiration Date: Type: Number: Expiration Date: List all machines equipment you can operate skillfully. List any foreign languages you speak, write or read fluently: In the space below, provide any additional information concerning your skills which qualifies you for the position you are seeking. Will you work overtime whenever scheduled or required? Yes No Can you work weekends whenever scheduled or required? Yes No Would you accept part-time work? Yes No Would you accept temporary work? Yes No Special skills you posses: (Electrical, Mechanical, Clerical or Technical): What hours are you available for work? What means of transportation will you use to get to work? Are you related by blood or marriage to the Mayor, any member of the City Council, or any employee of the city? Yes or No. If yes, state the name, relationship, title and department of such relative(s). NAME: RELATIONSHIP TITLE DEPARTMENT Have you ever been employed by the City? Yes or No. If yes, list department(s), position(s) held and dates of employment below. DEPARTMENT: JOB TITLE: FROM: TO: Do you reside within the corporate city limits? Yes or No. How long have you lived at your present address? Previous address: (Street or P O Box) (City) (State) (Zip) Are you legally eligible for employment in the U.S.A.? Yes or No. Date of Birth: Have you ever been convicted, forfeited collateral, or are you now under charges for any felony or any firearms or explosives offense against the law? Yes or No. If yes, list all such offenses and state the date, place, and action taken: . (Note: A conviction is not an automatic ban to employment; please provide complete information.) If you have a minimum salary requirement, you may indicate here: Per . CITY OF STANTON APPLICATION FOR EMPLOYMENT ******************************************************************************************** IN COMPLIANCE WITH FEDERAL AND STATE EQUAL EMPLOYMENT OPPORTUNITY LAWS, QUALIFIED APPLICANTS ARE CONSIDERED FOR ALL POSITIONS WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, MARTIAL STATUS, OR THE PRESENCE OF A NON-JOB-RELATED MEDICAL CONDITION OR HANDICAP. ******************************************************************************************** Do you wish to answer these questions? Yes No (Complete only identification data at bottom of page.) What is your Ethnic group? Asian Black Hispanic Indian (American) White Other What is your sex? Female Male What is your Age Category? Under 18 18 to 21 22 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 and up Are you a veteran of the U.S. Armed Forces? Yes No Name: (Please Print) Signature: Date: Your interest in our organization resulted from (you may check more than one if applicable): City Official/Employee Texas Employment Commission Local Newspaper Ad Private Employment Agency Ad in Journal Radio/Television Ad Ad in Newspaper Other (Specify)