P O Motor Vehicle

EMPLOYMENT APPLICATION

CITY OF GREENVILLE/GEUS

P.O. Box 1049

Greenville, Texas 75403

An Equal Opportunity Employer

www.ci.greenville.tx.us

Beginning with the most recent, list below the last four jobs held (with in the last ten years) and include your present employer, if employed. Include military and specifically describe various duties performed.

Name of Company and Address

Dates employed (Mo./Yr.)

Position Held

Type of Business

Salary

Starting Last

Describe in detail the work you did equipment operated, skills employed.

Name and Title of Supervisor

Phone:

Reason for leaving

Name of Company and Address

Dates employed (Mo./Yr.)

Position Held

Type of Business

Salary

Starting Last

Describe in detail the work you did equipment operated, skills employed.

Name and Title of Supervisor

Phone:

Reason for leaving

Name of Company and Address

Dates employed (Mo./Yr.)

Position Held

Type of Business

Salary

Starting Last

Describe in detail the work you did equipment operated, skills employed.

Name and Title of Supervisor

Phone:

Reason for leaving

Name of Company and Address

Dates employed (Mo./Yr.)

Position Held

Type of Business

Salary

Starting Last

Describe in detail the work you did equipment operated, skills employed.

Name and Title of Supervisor

Phone:

Reason for leaving

May we contact your present employer and previous employers?

Yes No If no, explain:

The Facts set forth in this application for employment are true and complete; I understand that

if employed, false statements on this application shall be considered sufficient cause for dismissal.

Signature of Applicant Date

NOTICE TO APPLICANTS:

The City of Greenville is an AT-Will Employer. Neither officer nor representative of the City of Greenville other than the City Council, has any authority to enter into any agreement or contract for employment for any period of time. Any employee’s employment and compensation can be terminated with or without cause and with of without notice, at any time, at the option of either the City or the employee.

BACKGROUND AND REFERENCE RELEASE AND AUTHORIZATION

Please be advised that any information, statement made or references given by any applicant for employment to the City of Greenville will be investigated by agents of the City of Greenville. Further, the City of Greenville reserves the right to make an in-depth investigation into the applicant’s character, general reputation, qualifications, and drivers record when applicable, to determine an applicants fitness for employment. This information is for the sole use of the City of Greenville and will not be released to third parties without the consent of the applicant.

I understand that motor vehicle reports, which may contain public and private record information, may be requested from ADR-American Driving Records. These reports may include but are not limited to the following types of information: name, address, social security number, date of birth, driver license or I.D. number, and driver record. I also understand that the information included in such report will be taken into consideration in deciding whether to offer me employment. I authorize, without reservation, any party or agency contacted by ADR to furnish the above mentioned information. I understand that: (1) ADR obtains all driver and vehicle information directly from the various state Department of Vehicles and does not maintain its own database of driver and vehicle information; (2) ADR acts as a courier and has no control over any of the information that a state discloses in my driver record or vehicle record; and (3) if there is something inaccurate on my driving or vehicle report, I must contact the DMV directly to have the information corrected or updated. I hereby authorize procurement of motor vehicle records.

Having read and understood the above statement, I give my full consent to the above and allow the City of Greenville the right to fully investigate my character, general reputation, background qualifications, and whatever else may be applicable.

Applicant for Employment Date

City of Greenville

TO WHOM IT MAY CONCERN:

This is your authority to furnish the representative of the City of Greenville any and all information, reports and records you may have in your possession, or your may have access to, concerning my character general reputation, qualifications, and whatever else may be applicable.

Applicant for Employment Date

City of Greenville

NOTICE TO APPLICANTS:

The City of Greenville/GEUS complies with the requirements of the Immigration Reform and Control Act of 1986. The City/GEUS will hire only United States citizens and aliens who are authorized to work in the United States. Newly hired employees who do not present the required documentation within three days of their hire date will be terminated.

Acceptable documents that establish identity and employment eligibility include the following:

(1)U.S. Passport, or

(2)Certificate of U.S. Citizenship, or

(3)Certificate of Naturalization, or

(4)Unexpired foreign passport with attached Employment Authorization, or

(5)Alien Registration Card, or

(6)A combination of 1) State issued drivers license or I.D. Card, U.S. Military Card, or other approved I.D. Card, and 2) Original Social Security Card, or U.S. Birth Certificate, or unexpired INS Employment Authorization.

(Other documents may be aceptable to prove identity, employment eligibility, or both)

DRUG SCREENING:

In compliance with the Drug Free Workplace Act of 1988 and the campaign to maintain a drug free Greenville the City of Greenville/GEUS conducts pre-employment urinalysis drug screens of various applicants. Applicants declining to voluntarily agree to a drug screen will not be considered further for employment. Applicants with confirmed positive results will not be considered for employment for a minimum period of six months from date of test.

AMERICANS WITH DISABILITIES ACT COMPLIANCE:

The City of Greenville/GEUS does not discriminate on the basis of disability in the admission or access to, or treatment of employment in, its programs or activities. Applicants for employment may request any reasonable accommodation to assist in the employment application or interview process. Questions or requests should be directed to the Human Resource Director, 2821 Washington Street, Greenville, Texas 754f03. 903-***-**** (Voice) or 903-***-**** (TDD).

INTERVIEWS AND FOLLOW-UP:

For posted job vacancies the hiring/interviewing department will review all referred applications and select the applicants to be interviewed. The interviewing department will call candidates to schedule interviews and select the applicant to be hired. Because of the volume of applications, telephone calls, and the time required to review each application, you will not be called or contacted unless you are selected for an interview.

THE CITY OF GREENVILLE/GEUS IS AN EQUAL OPPORTUNITY EMPLOYER

It is the policy of the City of Greenville/GEUS to offer Equal Opportunity Employment without regard to race, color, religion, national origin, disability, age or sex. Anyone feeling they have been discriminated against is encouraged to contact the City’s Human Resource Office, the U.S. Equal Employment Opportunity Commission, the Federal Communication Commission or other appropriate agency.

We are interested in finding out just how good, or how poor, a job we are doing as an Equal Opportunity Employer. The information that you provide us will be used to study recruiting and employment patterns and to determine whether information about job openings is reaching all segments of the community.

Please give us your cooperation by completing this questionnaire and returning it with your application.

NAME: DATE:

Last First MI

ADDRESS:

TITLE OF JOB APPLYING FOR:

IS THIS JOB: Full Time – Regular Full Time – Temporary Part Time

NOTES

Date

Name (Last, First, Middle)

Position Applied For

Address City, State Zip Code

Driver License Operator

# Commercial

State Chauffeurs

Cell Phone

E-Mail Address

Home Phone Work Phone Date Available for Work

Have you ever been employed by the City of Greenville?

Yes No

If yes: When Position

U.S. Citizen Yes No

Alien Registration No.

Do you have relatives working for the City of Greenville?

Yes No

Name Dept.

Name Dept.

Salary Expected

$ per

Have you served in the U.S. Armed Forces?

Branch

From To

Specialty

Have you ever been convicted, or pled guilty or no contest, or been charged with a crime? If so, when, where and disposition of offense. Yes No

Note: A conviction does not automatically mean you cannot be appointed. Give all facts and relevant details. For purposes of employment with the City of Greenville/GEUS, "convictions" include sentenced to confinement, paid fines, time served, placed on probation (including deferred adjudication) and court-ordered restitution.

EDUCATION

Are you a high School Graduate? Colleges Attended Dates

Yes No Year? Dates

High School Degree Earned Major

GED Certificate Date Graduated

Yes No Date Other

List all trade schools, military schools, Business College, etc.

Licenses, professional registration, special skills, machines operated, typing skills, etc.

CHECK ONE:

White (Non-hispanic)

Black (Non-hispanic)

Hispanic

Asian/Pacific Islander

American Indian or Alaskan Native

BIRTHDATE:

/ /

MM DD YYYY

CHECK ONE:

Male

Female

HOW DID YOU LEARN ABOUT THIS JOB?

Newspaper

Internet

City Employee

City Human Resource Office

Employment Agency or

TWC

Professional Publication

Other

CHECK THE HIGHEST LEVEL OF EDUCATION COMPLETED:

Grades 0-5 Associates Degree

Grades 6-8 Bachelors Degree

Grades 9-11 Masters Degree

High School Law Degree

GED Doctoral Degree

College Credit Hours

Contact this candidate