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					                        APPLICATION FOR EMPLOYMENT
                     GREELEY-WELD COUNTY AIRPORT AUTHORITY
The Greeley-Weld County Airport Authority is an Equal Opportunity Employer. We do not discriminate on the basis
of race, religion, national origin, color, sex, age, or disability. It is our intention that all applicants be given equal
opportunity and that selection decisions are based on job-related factors.

POSITION APPLIED FOR:                                                       TODAY’S DATE:

Type of Employment you desire: Full-time                        Part-time                    Temporary

Are you available for rotating shift work?    Yes                                    No

Rate of pay desired:                                       When could you start work?

PERSONAL DATA

                                                                                                -       -
Name (Last, First, MI)                                                               Social Security Number


Street Address                                                   City                     State           Zip Code

Telephone: Home (          )                  Business (         )                 Message (          )
If hired, can you furnish proof that you are eligible to work in the United States? Yes                     No

Are you 18 years of age or older? Yes              No

For driving jobs:

        All applicants must have possess a good driving record to be considered for employment.
        Do you have a valid Colorado Drivers License? Yes        No
        License Number                    State           Type: (circle) CDL C S


MILITARY
Branch of Service                                                             Dates: From                   To
Service duties:



GENERAL
Have you ever been an employee of the Greeley-Weld County Airport Authority? Yes                            No
       If yes, when?

Are any relatives employed by the Greeley-Weld County Airport Authority? Yes                          No


SPECIAL SKILLS (Related to the job for which you are applying)
Typing Speed:    Wpm

Do you have experience with:

        A personal computer? Yes                    No                  IBM or IBM clone? Yes                No

        Word Processing? Yes             No              Software used?

        Multi-Line Telephone? Yes             No
If you have any other skills, abilities, or licences related to work desired, or if you are an experienced operator of any
heavy equipment please list:




EDUCATION
Circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Received high school diploma? Yes             No         Or GED? Yes                No

List name and location of school(s)
High School (or GED):                                           Did you Graduate?              # of years attended

College or University:                                          Did you Graduate?              # of years attended

         Major:
         Type of Degree:

Additional education and/or vocational or technical training information:
School                                                                              Degree Received
                                                                                /
                                                                                /
                                                                                /
                                                                                /


WORK HISTORY
Are you presently employed? Yes              No
If so, may we contact your present employer? Yes               No
List names of employers in consecutive order with present or last employer first.
Attach Resume or additional sheets if necessary.

Name of Employer:                                                    Supervisor:

Address:                                                             Employed From:            /       To         /
Telephone:                                                           Pay: Start                    Final
Position Title:                                                      Reason for leaving:
Job Duties:




Name of Employer:                                                    Supervisor:

Address:                                                             Employed From:            /       To         /
Telephone:                                                           Pay: Start                     Final
Position Title:                                                      Reason for leaving:
Job Duties:




Name of Employer:                                                    Supervisor:
Address:                                                             Employed From:            /       To         /
Telephone:                                                           Pay: Start                     Final
Position Title:                                                      Reason for leaving:
Job Duties:
REFERENCES

Give three references, not relatives or former employers.
        NAME                           ADDRESS                              PHONE                 OCCUPATION

                           /                                       /                       /

                           /                                       /                       /

                           /                                       /                       /


AFFIDAVIT
I certify that the answers given to the foregoing questions are true and correct without consequential omissions of any
kind. I authorize the companies, schools, or persons named above to give any information regarding my employment,
character and qualifications. I hereby release these companies, schools or persons from the liability for any damage
for issuing this information. I understand and agree that any misleading or incorrect statements or omissions may
render this application void, and if employed, would be cause for termination. I understand that if employed, I have
been hired at the will of the employer and that my employment can be terminated at will, at any time; and with or
without cause the employer’s only obligation being to pay salary or wages due and owing at the time of the termination.

Signature                                                                              Date

				
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