Applicant s Last Name, First Position Applying For

Transcription

1 Applicant s Last Name, First Position Applying For CITY OF MOSS POINT EMPLOYMENT APPLICATION 4320 McInnis Street Moss Point, MS 39563

2 Applications only accepted for vacant positions. Applications are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or in the presence of non-related medical condition or handicap. Name Mailing Address Date City State Zip Permanent Position Applied For When Can You Start ( ) Full Time ( ) Part Time ( ) Temporary ( ) Other Are there any hours, shifts, or days you cannot work? How did you learn of this opening? Have you ever been convicted, fined, imprisoned, placed on probation, or given a suspended sentence by any court, including court martial, or have you forfeited bail in connection with any offenses? Include convictions dismissed following probation. Do not include juvenile offense if the record has subsequently been sealed by Court Order. Do not include traffic offenses unless they resulted in the issuance of a warrant. ( ) Yes ( ) No If yes, give the following information for each offense. Use additional sheets if necessary. Date Place Offense Sentence/and or Fine Are you over the age of 18? ( ) Yes ( ) No Are you authorized to work in U.S. on an unrestricted basis? ( ) Yes ( ) No Are you a citizen of the United States of America? ( ) Yes ( ) No Have you applied here before? ( ) Yes ( ) No When? Position applied for? Have you ever been employed with the City of Moss Point before? ( ) Yes ( ) No If so, what position? Are you related to any current employee of the City of Moss Point? ( ) Yes ( ) No If yes, who and in which department?

3 Professional Experience: Start with your present job or last job. Include military assignments and other volunteer activities. Exclude organizational names, which indicate race, color, religion, sex, or national origin. Employer 1 Employer 2 Employer 3 EMPLOYMENT APPLICATION PART 2 EDUCATION Schools/College Attended #Years Year Grad. Degree Describe any special qualifications for this job:

4 References Professional and Personal (Please do not include relatives or previous employers) Name Address Phone Years Known In case of emergency, please notify: Name Relationship Address Phone Number 1. Your Driver s License# State Expiration (This license must remain valid during the course of employment) Please read very carefully: I CERTIFY that answers on this form and on the application for employment are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for the employment as many necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or interview may result in termination. Applicant s license must remain valid during the course of employment: and invalid, suspended, revoked or expired license may result in termination of employment. I agree to submit myself, upon request, for a physical mental and/or drug examination by a physician designed by the City of Moss Point at the City of Moss Point s expense, and to future physical, mental, and/or drug/alcohol examinations that the City of Moss Point may require at a later date as a condition of continued employment. If, in the judgement of the City of Moss Point, any misrepresentation by false statement, omission, or inaccuracy has been made by me herein, or the results of such investigation that the City of Moss Point may make are not satisfactory, any offer or employment made by the City of Moss Point may be withdrawn or my employment may be terminated without any obligation or liability to me other than for payment or earnings at the rate agreed upon through the last day of employment. If employed, I agree to acquaint myself with, and to abide by all rules and regulations as established by the City of Moss Point. I further agree that any employment resulting from this application may be terminated at any time without liability to me for wages, salary, or other benefits except such wages specifically earned at the time and date of such termination. If employed, I understand that I must meet the city s residency requirement within 180 days of employment. Failure to do so could result in my termination. I further understand that the City can waiver or amend the residency at any time. If employed and requested by the City of Moss Point, I agree as a condition of continued employment, to submit to such polygraph examinations as the city shall require in conjunction with my employment. All union members are subject to probationary period as outlined in the union contract. Civil Service employees are subject to probationary period as outlined in the civil service contract. I have read and understand the foregoing statement of agreement and accept the terms stated therein. The City of Moss Point is an equal opportunity employer and does not discriminate based upon race, religion, sex, or age. Signature Date PESONNEL DEPARTMENT ONLY Remarks Interview report by

5 BACKGROUND CHECK ACKNOWLEDGEMENT FORM I hereby authorize the City of Moss Point and/or any its officers, or designees to investigate my background, references, character, education, past employment, and/or criminal records on order to confirm my qualifications for employment as represented on my resume and/or employment application, and/or in my employment interview. By signing below, I release the City of Moss point and/or its officers, or designees, as well as any person or entity providing information on my background pursuant to this acknowledgement form, from any and all liability in relations to the information obtained from any all of the above referenced sources used. Applicant s Signature: Date: Applicant s Full Legal Name: Applicant s Current Address: How long at this address: Driver s License No.: State of Issue: Date of Birth: Social Security No.: October 2016