Application for Employment

Name *

DOB *

Month

Day

Year

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? *

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 *

If yes, when? *

Have you ever been convicted of a crime in the past 10 years? (Excluding traffic violations) *

Yes

If yes, list convictions *

Are you 18 years or older? *

Yes

Do you have the legal right to remain in the United States? *

Yes

If yes, can you produce evidence of U.S citizenship or legal work status within (3) days? *

Yes

Do you have a valid Arkansas state drivers license? *

Can you perform the duties of the job for which you are applying with or without reasonable accommodations? *

Education

Did you graduate High School? *

Yes

If yes, where did you attend high school and what year did you graduate? *

Did you graduate college? *

Yes

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 History

Starting with most recent employer. Please list your last 3 employers.

Employer #1 *

Address *

Phone Number *

Start date *

Month

Day

Year

Starting Salary *

How often were you paid? *

weekly

bi-monthly

monthly

Starting position *

Date left *

Month

Day

Year

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

Day

Year

Starting Salary *

How often were you paid? *

weekly

bi-monthly

monthly

Starting position *

Date left *

Month

Day

Year

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

Day

Year

Starting Salary *

How often were you paid? *

weekly

bi-monthly

monthly

Starting position *

Date left *

Month

Day

Year

Salary when leaving *

Position when leaving *

Name of Supervisor *

Title of Supervisor *

Description of duties *

Reason for leaving *

References

Give 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

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 *

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