Job Application

City of Asbury Job Application

City of Asbury Application for Employment

Position applied for

Name

Date

Address

City, State and Zip

Telephone

Email Address

List any additional names you have used

The City complies with all child labor regulations. Are you at least 16 years old?

Have you ever been employed here before?

Are you legally eligible for employment in this country?

Date available for work

Checkbox Group

Full-time

Part-time

Seasonal

Are you able to meet the attendance requirements of this position?

Have you been convicted of a crime in the last seven (7) years?

Yes

If yes, please explain

Are you a high school graduate?

Yes

Do you have any relatives, including in-laws, currently employed by us?

Yes

If yes, state the name and relationship of the relative

Educational Background

Name and Location of College

Years completed

Diploma earned

Major Course of Study

List all computer software you can operate if application to the position.

List all construction equipment previously operated if applicable to the position.

Special Skills and Qualifications.

Employment History

Employer

Address

Phone

Job Title

Dates employed

Summary of Work Performed

Immediate Supervisor

Employer

Address

Phone

Job Title

Dates employed

Summary of Work Performed

Employer

Address

Phone

Job Title

Dates employed

Summary of Work Performed

Military Background (if applicable)

Branch of Service

Period of active duty

Discharge honorable?

Rank at discharge

Summarize the nature of work performed

Professional References

Name

Address

Phone

Name

Address

Phone

Name

Address

Phone

I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the City of Asbury's services whenever it is discovered.

I give the City of Asbury the right to contact and obtain information from all references, educational institutions, and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the City of Asbury and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.

I understand it is the City of Asbury’s policy not to refuse to hire a qualified individual with a disability because of that person’s need for reasonable accommodation as required by the ADA.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

I understand that post offer pre-employment drug and alcohol testing may be required, and that a positive test result will terminate any job offer.

It is understood that post offer pre-employment, successful completion of a medical exam and Physical Capacity Profile (PCP) is required for full-time employees in the Public Works and Police Departments before hiring is finalized. Medical exams and PCP testing will be conducted by a physician designated by the City of Asbury.

I authorize the City to conduct a driving record check if driving will be required in my position with the City, and will complete a criminal check regarding my background and further authorize all governmental agencies, departments, bureaus or related entities to release any and all information regarding my driving record and criminal history, if any, and also agree to prepare and sign any other form necessary to complete a criminal background check. I understand that a conviction is not an automatic bar to employment, but that the City will consider the seriousness and nature of the crime, the date of the conviction and the extent to any rehabilitation.

If I am hired, I understand that I may resign at any time, with or without cause and without prior notice, and the City of Asbury reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the City of Asbury other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.

The City of Asbury does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any application from consideration for employment on a basis prohibited by local, state, or federal law.

This application is current for only 60 days. At the conclusion of this time, if I have not heard from the City of Asbury and still wish to be considered for employment, it will be necessary to fill out a new application.

I represent and warrant that I have read and fully understand the foregoing, and seek employment under these conditions.

Yes

Signature of Applicant

Security Measure