Application for Employment

The City of Caldwell is committed to ensuring equal opportunities to all individuals. Your application will be considered without regard to age, race, religion, color, national origin, disability, veteran status, or any other basis prohibited by local, state or federal law. As you complete your application for employment, give special attention to experience relative to the job for which you are applying. Be specific and thorough and include all relevant experience. Position(s) Applied For:

__ Application Date:

Date Available:

Last Name: First Name: M.I.: Present Address: Street City State Zip

Contact Phone: Email: Are you willing to work: Full Time Part Time Temporary Acceptable Salary: $ per

If position requires driving, do you have a valid driver’s license? Yes No What State: What Class: Restrictions: Are you legally eligible for employment in the U.S.? Yes No

(Proof of U.S. citizenship or immigration status will be required upon employment) Do you qualify for veterans preference? Yes No (Copy of DD-214 Form required) Have you previously been employed by the City of Caldwell? Yes No If yes, when? If yes, was it under a different name? If you have relatives employed with the City of Caldwell, list names and how related: City of Caldwell

411 Blaine

Caldwell, Idaho 83605

(208) 455-

Fax: 208-***-****

www.cityofcaldwell.com

EDUCATION

Do you have a high school diploma or equivalent (GED)? Yes No Check the highest grade completed – not including college: 1 2 3 4 5 6 7 8 9 10 11 12 Special Training or Education beyond High School

Name of School/Location Major Course of Study Type of Degree Received EMPLOYMENT HISTORY

In the spaces below, please list the specific duties and responsibilities included in your work experience, beginning with your present or most recent employment. Employment verification may be made regarding all of your past experience. Please note if you do not want your present employer or any other employer contacted and provide a brief reason. Employer Name: Telephone:

Address: Dates of Employment:

Mo/Year to Mo/Year

Name of Supervisor: Starting Salary:

$

Job Title, Duties and Responsibilities (Be Specific): Ending Salary:

$

Reason for Leaving:

Employer Name: Telephone:

Address: Dates of Employment:

Mo/Year to Mo/Year

Name of Supervisor: Starting Salary:

$

Job Title, Duties and Responsibilities (Be Specific): Ending Salary:

$

Reason for Leaving:

Employment History (Continued)

Employer Name: Telephone:

Address: Dates of Employment:

Mo/Year to Mo/Year

Name of Supervisor: Starting Salary:

$

Job Title, Duties and Responsibilities (Be Specific): Ending Salary:

$

Reason for Leaving:

Employer Name: Telephone:

Address: Dates of Employment:

Mo/Year to Mo/Year

Name of Supervisor: Starting Salary:

$

Job Title, Duties and Responsibilities (Be Specific): Ending Salary:

$

Reason for Leaving:

Employer Name: Telephone:

Address: Dates of Employment:

Mo/Year to Mo/Year

Name of Supervisor: Starting Salary:

$

Job Title, Duties and Responsibilities (Be Specific): Ending Salary:

$

Reason for Leaving:

Please explain any gaps in your work history:

Please list any experience and/or skills that you feel would especially qualify you for this position, including professional registrations, journey-level licenses or other occupational certificates: Please list any applicable membership in technical/professional associations (exclude those which may disclose your race, color, religion or national origin):

List any job-related seminars attended or training received which you feel especially qualify you for this position

(excluding formal education):

Do you speak any languages other than English (Please list): REFERENCES

(Include individuals who are qualified to evaluate your capabilities. Do not include relatives). Name Address City State/Zip Phone

SIGNATURE OF APPLICANT

I certify that the information in this application are true, complete, and correct to the best of my knowledge. I understand that if employed, false statements or material omissions contained in my application papers, including facts not required by the application but which could affect employability and/or job performance, or failure to show evidence of my identity and legal authority to work in the U.S. will be considered sufficient cause for dismissal at any time. I understand that the City of Caldwell is an alcohol/drug free workplace, and that if I am offered employment, the offer will be contingent on my passing a pre-employment alcohol and/or drug test. I also understand that acceptance of an offer of employment does not create a contractual obligation and/or an expressed or implied employment contract between the City and myself for employment or continuation of employment. The City has my permission to contact my previous employers, review my personnel files and/or conduct whatever background checks are necessary to determine my fitness for work. I authorize persons, schools, current employer and previous employers named in this application to release information to the City of Caldwell and I release them from any liability, claims or damages of any nature that may result from furnishing the information requested. This application has been read by me in its entirety. Date Signature of Applicant

In order to assure equal employment opportunity, the City of Caldwell monitors recruitment and selection practices. We would appreciate your assistance by voluntarily completing this form to provide affirmative action data as well as veterans information if you are claiming veterans preference. Submission of this information is strictly voluntary. This information will be kept separate from the application and used for statistical data only. CITY OF CALDWELL

AFFIRMATIVE ACTION DATA REQUEST

Date: Position Applied For:

Name: Age:

Sex: Male Female Disabled: Yes No Race: African American Hispanic Asian American/Pacific Islander American Indian/Alaskan Native Caucasian How were you informed of this opening? Currently Employed by the City Walk-In Newspaper/Magazine Ad College Placement Office Private Employment Office Department of Employment City Website Other Website Other WAR ERA VETERANS PREFERENCE

Idaho Law provides veterans preference to State residents who have been in active service of the United States during a recognized war period as defined by federal law and providing required documentation. War veterans receive five (5) points preference. Disabled veterans with a service-connected disability of 10% or more and receiving compensation from the VA or a military department are eligible for ten (10) points preference. Spouses of disabled veterans may claim preference if they have a letter from a physician stating the veteran in unable to work due to disability. A widow/er of a disabled veteran may claim preference as long as he/she remains unmarried. Recognized War Periods Include: World War II 12/07/41 to 12/31/46 Korean Conflict 06/27/50 to 01/31/55

Vietnam War 02/28/61 to 08/04/64

Vietnam Conflict 08/05/64 to 05/07/75

Persian Gulf War 08/02/90 to (Date not

yet proclaimed)

To receive consideration for veterans preference, you must complete the following checklist and submit all necessary documents.

Date: Position Applied For: Name:

ALL VETERANS

1. You must submit a DD-214 form or, if currently enlisted, military enlistment papers. 2. I have served during a recognized war period: Yes No Dates of Service from to

DISABLED VETERANS

3. You must submit a current VA certification letter (dated within the last 12 months) SPOUSES OF DISABLED VETERANS

4. If you are the spouse of a disabled war veteran claiming veteran’s preference, you must submit a letter from a physician verifying the veteran is unable to perform the work for which you are applying. 5. Are you divorced from the veteran? Yes No 6. Is the veteran deceased? Yes No

7. Have you remarried? Yes No

Referred by:

Contact this candidate