CITY OF BRADENTON BEACH APPLICATION FOR EMPLOYMENT We consider applications for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation or any other legally protected status. (PLEASE PRINT CLEARLY) Last Name: First Name: Middle Name: Position Applied For: Date of Application: _________________________________________________________________________________________ How did you learn about us? Advertisement Friend Walk-in Employment Agency Relative Other: Address: Street: City: State: Zip: __________________________________________________________________________________________ Telephone Number(s): Last 4 digits of Social Security Number: Email(s): If you are under the age of 18 years of age, can you provide YES NO required proof of eligibility to work? Have you ever filed an application with us before? YES NO Have you ever been employed with us before? YES NO Are you currently employed? YES NO May we contact your present employer? YES NO Are you prevented from lawfully becoming employed in this Country because of a Visa or Immigration status? YES NO (Proof of citizenship or immigration status will be required upon employment) On what date would you be available for work? Are you available for work? Full Time Part Time Shift Work Temporary Are you currently on “lay-off” status and subject to recall? YES NO Can you travel if the job requires it? YES NO Have you ever been convicted of a felony within the last 7 years? (Conviction will not necessarily disqualify an applicant from employment) YES NO If yes, Please explain: WE ARE AN EQUAL OPPORTUNITY EMPLOYER  CITY OR BRADENTON BEACH – APPLICATION FOR EMPLOYMENT Page |2 EDUCATION Name and Address of Years Course of Study Diploma/Degree School Completed Elementary School High School Undergraduate College Graduate Professional Other (Specify) Indicate Any Foreign Languages You Can Speak, Read Or Write. Fluent Good Fair Speak Read Write Describe any specialized training, apprenticeship, skills and extra – curricular activities: Describe any job – related training received in the United States Military.  CITY OR BRADENTON BEACH – APPLICATION FOR EMPLOYMENT Page |3 EMPLOYMENT EXPERIENCE Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. If you need additional space, please continue on a separate sheet of paper. Employer: Dates Employed: 1 From: To: Job Title: Hourly Rate / Salary: Starting: $ Final: $ Supervisor: Telephone #(s): Address: Work Preformed: Reason For Leaving: Employer: Dates Employed: 2 From: To: Job Title: Hourly Rate / Salary: Starting: $ Final: $ Supervisor: Telephone #(s): Address: Work Preformed: Reason For Leaving: 3 Employer: Dates Employed: From: To: Job Title: Hourly Rate / Salary: Starting: $ Final: $ Supervisor: Telephone #(s): Address: Work Preformed: Reason For Leaving: Employer: Dates Employed: 4 From: To: Job Title: Hourly Rate / Salary: Starting: $ Final: $ Supervisor: Telephone #(s): Address: Work Preformed: Reason For Leaving: List of Professional, trade, business or civic activities and offices held. You may exclude membership in which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.  CITY OR BRADENTON BEACH – APPLICATION FOR EMPLOYMENT Page |4 ADDITIONAL INFORMATION Other Qualifications: Summarize Special Job–Related Skills And Qualifications Acquired From Employment Or Other Experience. Specialized Skills: Check Skills / Equipment Operated Production / Mobile / Machinery (list): Word Excel Asyst Citizen Serve Outlook Printer Other (list): State Any Additional Information You Feel May Be Helpful To Us In Considering Your Application: NOTE TO APPLICANTS: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING. Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? (A description of the activities involved in such a job or occupation is attached). _____YES _____ NO REFERENCES: ( ) 1 (Name) Phone # (Address) ( ) 2 (Name) Phone # (Address) ( ) 3 (Name) Phone # (Address)  CITY OR BRADENTON BEACH – APPLICATION FOR EMPLOYMENT Page |5 APPLICANT’S STATEMENT I Certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire whether or not applications are being accepted at this time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by contract unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulation of the employer. / / Signature of applicant Date FOR PERSONEL DEPARTMENT USE ONLY Arrange Interview: YES NO Remarks: Employed: YES NO Date of Employment: / / Position Applied For: Hourly/Salary Rate $: Department: By: Date: / / (NAME AND TITLE) NOTES: CITY OR BRADENTON BEACH – APPLICATION FOR EMPLOYMENT Page |6