Name * DOB * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Social Security Number * Address * How long have you lived at the above address? * Previous Address * How long have you lived at the previous address? * Phone Number * What position are you applying for? * - Select -Water DepartmentStreet DepartmentPark Department Work schedule * Full Time Part Time Resume Files must be less than 5 MB.Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods avi mov mp3 ogg wav. Rate of pay expected per hour * How did you hear about his opening? * Have you worked with us before? If yes, when and how long? * Previous job title * Reason for leaving * List any friends/relatives working for the City of Pottsville now * List any special skills you have for positions applied for above * Have you ever been bonded * - Select -NoYes If yes, when? * Have you ever been convicted of a crime in the past 10 years? (Excluding traffic violations) * No Yes If yes, list convictions * Are you 18 years or older? * Yes No Do you have the legal right to remain in the United States? * Yes No If yes, can you produce evidence of U.S citizenship or legal work status within (3) days? * Yes No Do you have a valid Arkansas state drivers license? * - Select -YesNo Can you perform the duties of the job for which you are applying with or without reasonable accommodations? * - Select -YesNo Education Did you graduate High School? * Yes No If yes, where did you attend high school and what year did you graduate? * Did you graduate college? * Yes No If yes, where did you attend college and what year did you graduate? * What was your major in college? What diploma/degree have you received? * List any other training or education including tech schools * If this doesn't pertain to you please enter N/A in the textarea. Work HistoryStarting with most recent employer. Please list your last 3 employers. Employer #1 * Address * Phone Number * Start date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Starting Salary * How often were you paid? * weekly bi-monthly monthly Starting position * Date left * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Salary when leaving * Position when leaving * Name of Supervisor * Title of Supervisor * Description of duties * Reason for leaving * Employer #2 * Address * Phone Number * Start date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Starting Salary * How often were you paid? * weekly bi-monthly monthly Starting position * Date left * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Salary when leaving * Position when leaving * Name of Supervisor * Title of Supervisor * Description of duties * Reason for leaving * Employer #3 * Address * Phone Number * Start date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Starting Salary * How often were you paid? * weekly bi-monthly monthly Starting position * Date left * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Salary when leaving * Position when leaving * Name of Supervisor * Title of Supervisor * Description of duties * Reason for leaving * ReferencesGive the names and addresses of three (3) persons, other than relatives, who have knowledge of your character, experience or ability. Name #1 * Address * Phone Number * Occupation * Name #2 * Address * Phone Number * Occupation * Name #3 * Address * Phone Number * Occupation * Parks Department Job Description This position is responsible for the maintenance of park facilities, grounds, and equipment. Performs both skilled and non-skilled tasks including carpentry, electrical, plumbing, cleaning, ground keeping, trash removal, and vehicle maintenance. Conducts job performance evaluations, maintains equipment history records, coordinates work assignments, and develops an overall park maintenance plan and preventive maintenance program. Supervises community service workers and volunteers involved in park maintenance projects. Must be able to work a flexible schedule, including some weekends and holidays. A valid driver’s license is required, and a driver’s record check will be performed. Only full time employees receive full benefit package including paid holidays, annual and sick leave, health insurance, and retirement pension. ANY CITY EMPLOYEE MAY BE REQUIRED TO WORK IN ALL CITY DEPARTMENTS AS NEEDED. I have read and verified that the information on this document is accurate. Signature * Leave this field blank