Manager Information

(AN EQUAL OPPORTUNITY EMPLOYER)

PERSONAL INFORMATION DATE

SOCIAL SECURITY

NAME NUMBER

LAST FIRST MIDDLE

PRESENT ADDRESS

STREET CITY STATE ZIP

PERMANENT ADDRESS

STREET CITY STATE ZIP

PHONE NO. ARE YOU 18 YEARS OR OLDER?

ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED

IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS? EMPLOYMENT DESIRED

DATE YOU SALARY

POSITION CAN START DESIRED

IF SO MAY WE INQUIRE

ARE YOU EMPLOYED NOW? OF YOUR PRESENT EMPLOYER?

EVER APPLIED TO THIS COMPANY BEFORE? WHERE? WHEN?

REFERRED BY

*NO OF

YEARS

ATTENDED

*DID YOU

GRADUATE?

GENERAL

SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK

SPECIAL SKILLS

ACTIVITIES: (CIVIC, ATHLETIC, ETC.)

EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED, SEX, AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS. RANK

APPLICATION FOR EMPLOYMENT

(PRE-EMPLOYMENT QUESTIONNAIRE)

SUBJECTS STUDIED

EDUCATION

U.S. MILITARY OR NAVAL

SERVICE

PRESENT MEMBERSHIP

IN NATIONAL GUARD OR

RESERVES

NAME AND LOCATION OF SCHOOL

GRAMMAR SCHOOL

COLLEGE

TRADE, BUSINESS, OR

CORRESPONDENCE

SCHOOL

HIGH SCHOOL

SALARY POSITION

FROM

TO

FROM

TO

FROM

TO

WHICH OF THESE JOBS DID YOU LIKE BEST?

WHAT DID YOU LIKE MOST ABOUT THIS JOB?

REFERENCES GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR. THE FOLLOWING STATEMENT APPLIES IN: MARYLAND & MASSACHUSETTS. (FILL IN NAME OF STATE) IT IS UNLAWFUL IN THE STATE OF TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY. Signature of Applicant

IN CASE OF

EMERGENCY NOTIFY

NAME ADDRESS PHONE NO

"I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE CITY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE. AT ANY TIME, AT EITHER MY OR THE CITY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE CITY. I UNDERSTAND THAT NO CITY REPRESENTATIVE, OTHER THAN IT'S CITY COUNCIL, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE CITY COUNCIL, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING."

DATE SIGNATURE

INTERVIEWED BY DATE

REMARKS

NEATNESS ABILITY

HIRED POSITION DEPT

SALARY/WAGE DATE REPORTING TO WORK

APPROVED: 1. 2 3

FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST.) DATE MONTH AND YEAR NAME AND ADDRESS OF EMPLOYER REASON FOR LEAVING NAME ADDRESS BUSINESS YEARS ACQUAINTED

EMPLOYMENT MANAGER DEPT. HEAD CITY MANAGER

1

2

3

DO NOT WRITE BELOW THIS LINE

Contact this candidate