Employment Application

First Name

Middle Name

Last Name

Today’s Date

If employed or attended school under last name other than present, indicate Name(s) used.

Current Address

Street

City

State

Zipcode

Phone

Addresses for the past 10 years. (Do not include present address).

Street

City

State

From Month/Year

To Month/Year

Street

City

State

From Month/Year

To Month/Year

Street

City

State

From Month/Year

To Month/Year

Street

City

State

From Month/Year

To Month/Year

Street

City

State

From Month/Year

To Month/Year

Street

City

State

From Month/Year

To Month/Year

Street

City

State

From Month/Year

To Month/Year

Street

City

State

From Month/Year

To Month/Year

How long, immediately previous to this application, have you lived in Marshall, Missouri?

Type of Work Desired

Weekly Salary Requirement

Other kinds of work you can do

Date Available for Employent

Are you a U.S. Citizen?

Yes

Have you a legal right to remain permanently in the U.S.?

Yes

Have you ever been convicted of a crime?

Yes

What, when, where & penalty (exclude minor traffic violations)

Have you ever worked for the City of Marshall?

Yes

What Dates?

Location

Reason for Leaving

If you haven’t worked for the City of Marshall have you made an application?

Yes

On what dates?

Have you any relatives or friends working for the City of Marshall?

Yes

Name and Relation

Present Employer (or Period of Unemployment)

The City of Marshall hereby states that your application will be kept strictly confidential and your present employer will not be contacted without your permission. Please give a complete record of your past and present employment, accounting for all time, whether unemployed or in armed services, for the past ten years or since leaving high school. If you are unemployed, or have been self-employed for more than 30 days, give the names of two persons (not relatives) who can verify this fact. The City of Marshall may conduct a routine inquiry before initial employment, or subsequently during employment. That inquiry may include such information as character, general reputation, personal characteristics and mode of living. If the City of Marshall does conduct and inquiry, the nature and scope will be disclosed to you upon your written request.

Your Position

Give Job Title and Description of your Duties

Pay/Salary when started

Pay/Salary when left

Reason for Leaving

Discharged

Laid Off

Other Reason for Leaving

From Month/Year

To Month/Year

Name of Company in Full

Indicate Nature of Business.

Address

Street, City, State, Zip

Phone

Department and Name of Your Supervisor

Previous Employment – Last Employer (or period of unemployment)

Your Position

Give Job Title and Description of your Duties

Pay/Salary when started

Pay/Salary when left

Reason for Leaving

Discharged

Laid Off

Other Reason for Leaving

From Month/Year

To Month/Year

Name of Company in Full (Present Employer or Period of Unemployment)

Indicate Nature of Business.

Address

Street, City, State, Zip

Phone

Department and Name of Your Supervisor

Previous Employment – Second Former Employer (or period of unemployment)

Your Position

Give Job Title and Description of your Duties

Pay/Salary when started

Pay/Salary when left

Reason for Leaving

Discharged

Laid Off

Other Reason for Leaving

From Month/Year

To Month/Year

Name of Company in Full (Present Employer or Period of Unemployment)

Indicate Nature of Business.

Address

Street, City, State, Zip

Phone

Department and Name of Your Supervisor

Previous Employment – Third Former Employer (or period of unemployment)

Your Position

Give Job Title and Description of your Duties

Pay/Salary when started

Pay/Salary when left

Reason for Leaving

Discharged

Laid Off

Other Reason for Leaving

From Month/Year

To Month/Year

Name of Company in Full (Present Employer or Period of Unemployment)

Indicate Nature of Business.

Address

Street, City, State, Zip

Phone

Department and Name of Your Supervisor

Previous Employment – Fourth Former Employer (or period of unemployment)

Your Position

Give Job Title and Description of your Duties

Pay/Salary when started

Pay/Salary when left

Reason for Leaving

Discharged

Laid Off

Other Reason for Leaving

From Month/Year

To Month/Year

Name of Company in Full (Present Employer or Period of Unemployment)

Indicate Nature of Business.

Address

Street, City, State, Zip

Phone

Department and Name of Your Supervisor

Can you operate an automobile?

Yes

Can you operate a typewriter?

Yes

Touch or Sight?

Yes

Speed?

Yes

Driver’s License Number

Do you have a CDL classification

Yes

If yes, which?

References

Give the names of three responsible persons, other than relatives or past employers, who know you well enough to give information about you.

Name

Address

Phone

Occupation

Years known

Name

Address

Phone

Occupation

Years known

Name

Address

Phone

Occupation

Years known

In Case of Emergency Notify

First Name

Middle Name

Last Name

Phone

Street

City

State

Zipcode

What previous job did you like best?

Why?

What previous job did you like least?

Why?

Education – High School

Name of School and Location

Did you graduate?

Yes

Scholastic Standing

Years or Hours of Credit

Major and Minor Fields of Study

Degree

Education – College/University

Name of School and Location

Did you graduate?

Yes

Scholastic Standing

Years or Hours of Credit

Major and Minor Fields of Study

Degree

Education – Graduate

Name of School and Location

Did you graduate?

Yes

Scholastic Standing

Years or Hours of Credit

Major and Minor Fields of Study

Degree

Education – Business/Trade School

Name of School and Location

Did you graduate?

Yes

Scholastic Standing

Years or Hours of Credit

Major and Minor Fields of Study

Degree

Percent of college expenses earned? (exclude government aid)

Approximate number of hours worked per week during school year?

General Information

Please describe in detail the ways in which your training experience, and extracurricular activities qualify you for employment with our organization. Include specialized school courses, skills, hobbies, interests, scholastic honors and offices held. Exclude activities which would disclose race, color, creed, or national origin.

Military Service

Armed Forces of the United States of America

Branch of Service

Active Duty Period of Service

Describe principal duties performed while in service

Service schools or special experience

Present Reserve Status

Branch of Service

When completed

Date

Signature

Clear

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