1. Position Applied For:*

2. Last Name:*

First Name:

M.I.

3. Address:*

4. Contact Telephone:*

5. Email:

6. Drivers License Number:

*

6a. State:*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

7. Are you a U.S. Citizen?
If not a citizen the type of work permit in Block 20*

Yes

No

8. Have you ever been discharged or terminated for reasons other than lay off, lack of work; or have you ever resigned to avoid discharge?
*

Yes

No

9. Were you in the US Armed Forces?*

Yes

No

9a. If yes, What Branch?

9b. Duty Dates: (mm/dd/yyyy-mm/dd/yyyy)

9c. Rank at Discharge:

9d. Type of Discharge:

10. Are you at least 18 years old?
(21 years for Police/Fire)*

Yes

No

11. Do you have relatives working for the city?
If yes, give name and relationship in Block 20*

Yes

No

12. Have you ever been employed by the CIty of College Park?*

Yes

No

13. Have you ever been convicted of a felony, high misdemeanor involving moral turpitude, or have you ever entered a guilty plea or a nolo contendre plea to criminal charges?
If yes, explain in Block 20*

Yes

No

14. List equipment you can operate and level of proficiency. (250 characters max)*

15. List any other names under which you have worked, applied for work, or attended school

16. How did you hear about this position?
Check all that apply*

Newspaper GMA

Website Other

Education

17. Education: Have you passed a GED Test?

Yes

No

If yes, give date: (mm/dd/yyyy)

Select highest level of education attained.

GED HS BS

MS Other

Name and Location of ALL schools attended include High School, Technical, Military, College, etc.

School Attended (Name & Address)*

From: (mm/dd/yyyy)

To:(mm/dd/yyyy)

Major Coursework:

Degrees/Certificates:

School Attended: (Name & Address)*

From:(mm/dd/yyyy)

To:(mm/dd/yyyy)

Major Coursework:

Degress/Certificates:

School Attended: (Name & Address)

From:(mm/dd/yyyy)

To: (mm/dd/yyyy)

Major Coursework:

Degrees/Certificates:

School Attended:(Name & Address)

From: (mm/dd/yyyy)

To: (mm/dd/yyyy)

Major Coursework:

Degress/Certificates:

Work And Professional Experience

18. List any licenses, certificates, permits or special skills you may have. Describe other experiences, skills or qualifications which are applicable. (250 characters max)

19. Experience:
Begin with your current or most recent job. List all jobs, including military service, along with periods of unemployment. Be sure to describe the work you did fully and make note of any promotions you received. Attach additional pages if necessary.

From/To: mm/dd/yyyy-mm/dd/yyyy

Full Time

Yes

No

Name of Employer:

Address:
City/State/Zip

Total months worked:

Title:

Duties:

Beginning Salary:

Ending Salary:

Supervisor's Name:

Phone:

Reason for Leaving:

May we contact?

Yes

No

From/To: (mm/dd/yyyy-mm/dd/yyyy)

Full Time

Yes

No

Name of Employer:

Address:
City/State/Zip

Total months worked:

Title:

Duties:

Beginning Salary:

Ending Salary:

Supervisor's Name:

Phone:

Reason for Leaving:

May we contact?

Yes

No

From/To: mm/dd/yyyy-mm/dd/yyyy

Full Time

Yes

No

Name of Employer:

Address:
City/State/Zip

Total months worked:

Title:

Duties:

Beginning Salary:

Ending Salary:

Supervisor's Name:

Phone:

Reason for Leaving:

May we contact?

Yes

No

From/To: mm/dd/yyyy-mm/dd/yyyy

Full Time:

Yes

No

Name of Employer:

Address:
City/State/Zip

Total months worked:

Title:

Duties:

Beginning Salary:

Ending Salary:

Supervisor's Name:

Phone:

Reason for Leaving:

May we contact?

Yes

No

From/To: mm/dd/yyyy-mm/dd/yyyy

Full Time:

Yes

No

Name of Employer:

Address:
City/State/Zip

Total months worked:

Title:

Duties:

Beginning Salary:

Ending Salary:

Supervisor's Name:

Phone:

Reason for Leaving:

May we contact?

Yes

No

From/To: mm/dd/yyyy-mm/dd/yyyy

Name of Employer:

Address:
City/State/Zip

Total months worked:

Title:

Duties:

Beginning Salary:

Ending Salary:

Supervisor's Name:

Phone:

Reason for Leaving:

May we contact?

Yes

No

From/To: mm/dd/yyyy-mm/dd/yyyy

Full Time

Yes

No

Name of Employer:

Address:
City/State/Zip

Total months worked:

Title:

Duties:

Beginning Salary:

Ending Salary:

Supervisor's Name:

Phone:

Reason for Leaving:

May we contact?

Yes

No

20. Other Information

21. Personal References:
List three persons who have knowledge of your character or abilities. Do not include relatives or former supervisors.

Name:
Address:
City/State/Zip

Business/Occupation:

Phone:

Name:
Address:
City/State/Zip

Business/Occupation:

Phone:

Name:
Address:
City/State/Zip

Business/Occupation:

Phone:

Certification

22. Certification
I hereby certify that the answers by me to the foregoing questions and statements made by me are full and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application or any supplements thereto, is cause for rejection of my application or discharge at any time during my employment. I voluntarily authorize my former employers, schools, and persons named herein to give information regarding me. I hereby release said organizations or persons from any liability or damages whatsoever. I also authorize a background investigation to be carried out, to include a City sponsored lie detector test.

I understand that as a condidtion of employement, I will be required to pass an employment physical (including drug screen) and any future physical examination required by the City. I understand that such employment is subject to the policies of the City and the passing of any required written, physical agility, or skill examination. It is understood that the use of this form does not indicate that there are any position openings, and does not in any way obligate the City.

Signed:

Enter your name as authorized signature:*

Date: mm/dd/yyyy

AN EQUAL OPPORTUNITY EMPLOYER

The following is to be completed on a voluntary basis and will be separated from the application. Information will be used on a composite basis for statistical and compliance reporting purposes. Failure to complete will in no way affect consideration of your application.

Position Applied For:

Sex:

Race:

Marital Status:

Date: mm/dd/yyyy

City of College Park is an Equal Opportunity Employer