City of Freeman Online Job Application Form Name * First Name Last Name Social Security Number * Present Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Permanent Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Are you 18 years or older? * Yes No Phone * (###) ### #### Desired Employment Position * Date You Can Start * MM DD YYYY Desired Salary * $ Are you employed now? * Yes No If employed - may be contact your present employer? Yes No Ever applied with the City of Freeman before? * Yes No If so, when and in what position? * Ever worked for the City of Freeman before? * Yes No If so, when and in what position and reason for leaving? Checkbox Employment Agency Newspaper Advertising Friend State Employment Office College Placement Service Walk In Other Education Elementary Education * • Name of school • Years attended • Did you graduate? • Subjects studied High School Education * • Name of school • Years attended • Did you graduate? • Subjects studied College • Name of school • Years attended • Did you graduate? • Subjects studied Trade, business or correspondence school General Subjects of special study or research work * Special Training * Special Skills * Former Employer #1 Name of present or last employer * Last Employers Address * Address 1 Address 2 City State/Province Zip/Postal Code Country State Date * MM DD YYYY End Date * MM DD YYYY Job Title * Weekly Starting Salary * $ Weekly Ending Salary * $ May we contact your supervisor? * Yes No Supervisor Name, Title and Phone * Description of work * Reason for leaving * Former Employer #2 Name of previous employer * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Start date * MM DD YYYY End Date * MM DD YYYY Job Title * Weekly Starting Salary * $ Weekly Final Salary * $ May we contact your supervisor? * Yes No Supervisor Name, Title and Phone * Description of work * Reason for leaving * Former Employer #3 Name of previous employer * Address of previous employer * Address 1 Address 2 City State/Province Zip/Postal Code Country Start date * MM DD YYYY End date * MM DD YYYY Job Title * Weekly Starting Sarlary * $ Weekly Ending Salary * $ May we contact your supervisor? * Yes No Supervisor Name, Title and Phone * Description of work * Reason for leaving * References Give the names of three persons you are not related to, whom you have known at least one year. Reference #1: Name, Address, Business, Years Acquainted * Reference #2: Name, Address, Business, Years Acquainted * Reference #3: Name, Address, Business, Years Acquainted * Service Record Branch of service, discharge date and rank. Criminal History Have you been convicted of a felony within the last 5 years? * Yes No If yes, please explain. (will not necessarily exclude you from consideration) Resume In addition to my completed application above, I will be emailing my resume to mdwalter@gwtc.net. Yes No Authorization "I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES AND EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE AND RELEASE THE COMPANY FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION. I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED COMPANY REPRESENTATIVE." Signautre * By typing your name in the field below, you agree that you have read and understand the above authorization. Application Date * MM DD YYYY Thank you for your interested in a position at the City of Freeman. Your application has been received.
