Employment-Applications---City-of-Pass-Christian

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					LAST_________________________

P.O. BOX APPLICATION FOR EMPLOYMENT PASS CHRISTIAN,368 39571 MS PRE-EMPLOYMENT QUESTIONAIRE; AN EQUAL OPPORTUNITY EMPLOYER
PERSONAL INFORMATION NAME: (LAST) PRESENT ADDRESS: PERMANENT ADDRESS: PHONE: (FIRST) CITY CITY (MI) SSN: STATE STATE CELL: ZIP ZIP

CITY OF PASS CHRISTIAN

FIRST_____________________

POSITION: ARE YOU EMPLOYED NOW?

DATE YOU CAN START:

SALARY DESIRED:

IF SO, MAY WE CONTACT YOUR PRESENT EMPLOYER?

DESIRED EMPLOYMENT

HAVE YOU EVER APPLIED FOR EMPLOYMENT WITH THE CITY OF PASS CHRISTIAN? WHEN? WHAT DEPARTMENT? IF SO, WHEN DID YOU START? WHEN DID YOU LEAVE? SUPERVISOR'S NAME?

REASON FOR LEAVING? MI________

WHO REFERRED YOU TO US?

SCHOOL LEVEL

NAME AND LOCATION OF SCHOOL

YEARS DID YOU ATTENDED GRADUATE?

SUBJECTS STUDIED:

GRAMMER SCHOOL

EDUCATION

HIGH SCHOOL

COLLEGE
TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL

OTHER COLLEGE OR SCHOOL

SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK:

SPECIAL TRAINING:

GENERAL

SPECIAL SKILLS: OTHER:

NAME:_______________________________
LIST YOUR LAST THREE EMPLOYERS, STARTING WITH THE MOST RECENT
NAME OF PRESENT OR LAST EMPLOYER:

EMPLOYMENT HISTORY

ADDRESS: STARTING DATE: STARTING SALARY: NAME OF SUPERVISOR: DESCRIPTION OF WORK: LEAVING DATE: FINAL SALARY: TITLE:

CITY: JOB TITLE:

STATE:

ZIP:

MAY WE CONTACT YOUR SUPERVISOR? PHONE #:

REASON FOR LEAVING:

NAME OF PREVIOUS EMPLOYER: ADDRESS: STARTING DATE: STARTING SALARY: NAME OF SUPERVISOR: DESCRIPTION OF WORK: LEAVING DATE: FINAL SALARY: TITLE: CITY: JOB TITLE: MAY WE CONTACT YOUR SUPERVISOR? PHONE #: STATE: ZIP:

REASON FOR LEAVING:

NAME OF PREVIOUS EMPLOYER: ADDRESS: STARTING DATE: STARTING SALARY: NAME OF SUPERVISOR: DESCRIPTION OF WORK: LEAVING DATE: FINAL SALARY: TITLE: CITY: JOB TITLE: MAY WE CONTACT YOUR SUPERVISOR? PHONE #: STATE: ZIP:

REASON FOR LEAVING:

NAME:____________________________
LIST THE NAMES OF THREE PERSONS TO WHOM YOU ARE NOT RELATED THAT YOU HAVE KNOWN AT LEAST ONE YEAR:

NAME

ADDRESS

OCCUPATION

YEARS ACQUAINTED

REFERENCES

LIST THE NAMES OF THREE RELATIVES

NAME

ADDRESS

OCCUPATION

HOW RELATED

BRANCH OF SERVICE:

ARE YOU CURRENTLY ENLISTED?

SERVICE RECORD

RANK/RATE AT DISCHARGE:

TYPE OF DISCHARGE:

DUTIES WHILE ON ACTIVE DUTY/RESERVE:

OTHER TRAINING, SCHOOLS, OR KSA'S THAT APPLY TO THIS JOB:

HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST 5 YEARS?

YES /

NO

LEGAL AUTHORIZATION

IF YES, PLEASE EXPLAIN. (WILL NOT NECESSARILY EXCLUDE YOU FROM CONSIDERATION):

TRAFFIC TICKETS? EXPLAIN:

I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND I UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. I AUTHORIZE THE 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 CITY OF PASS CHRISTIAN FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION. I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE CITY OF PASS CHRISTIAN HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, NOR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED CITY REPRESENTATIVE.

SIGNATURE

DATE

DO NOT WRITE ON THIS PAGE FOR INTERVIEWER'S USE ONLY
EMPLOYER'S/SUPERVISOR'S NAME: DATE:

EMPLOYMENT

COMMENTS: EMPLOYER'S/SUPERVISOR'S NAME: COMMENTS: DATE:

NCIC RECORD:

DATE:

CRIMINAL

COMMENTS: OTHER BACKGROUND INFORMATION: COMMENTS: DATE:

INTERVIEWED BY:

DATE:

INTERVIEW

COMMENTS:

INTERVIEWED BY:

DATE:

INTERVIEW

COMMENTS:

INTERVIEWED BY:

DATE:

INTERVIEW

COMMENTS:

APPROVED PATROL SUPERVISOR: Y / N APPROVED HARBOR ADMINISTRATOR: Y / N APPROVED HARBOR MASTER/PATROL CHIEF: Y / N DATE HIRED: SALARY/WAGES: DEPARTMENT: POSITION: STARTING DATE:

DATE: DATE: DATE:

DO NOT WRITE ON THIS PAGE FOR INTERVIEWER'S USE ONLY
EMPLOYER'S/SUPERVISOR'S NAME: DATE:

EMPLOYMENT

COMMENTS: EMPLOYER'S/SUPERVISOR'S NAME: COMMENTS: DATE:

NCIC RECORD:

DATE:

CRIMINAL

COMMENTS: OTHER BACKGROUND INFORMATION: COMMENTS: DATE:

INTERVIEWED BY:

DATE:

INTERVIEW

COMMENTS:

INTERVIEWED BY:

DATE:

INTERVIEW

COMMENTS:

INTERVIEWED BY:

DATE:

INTERVIEW

COMMENTS:

APPROVED INTERVIEWED BY/TITLE: Y / N APPROVED INTERVIEWED BY/TITLE: Y / N APPROVED INTERVIEWED BY/TITLE: Y / N DATE HIRED: SALARY/WAGES: DEPARTMENT: POSITION: STARTING DATE:

DATE: DATE: DATE:


				
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Description: Employment-Applications---City-of-Pass-Christian