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City of Alabaster Personnel Department 201 1st Street N. Alabaster, Al. 35007

APPLICATION FOR EMPLOYMENT Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Position(s) applied for ______________________ Date of application ____/____/____ Name _____________________________________________________________________ Last First Middle Address ___________________________________________________________________ Street City State Zip Telephone # (_____)_______________ Mobile/Other Phone #(_____)______________ Social Security # __________________________ If you are under 18, and it is required, can you furnish a work permit? Yes No If no, please explain ______________________________________________________ Do you have any relatives who work for the City? _______ Relationship ____________ Name of relative ________________________________________________________. Have you ever been employed here before? ________________________ Are you legally eligible for employment in this country? ____________

Yes Yes

No No

Date available for work. __________________________________________/___/____ Type of employment desired

Fulltime

Part-Time

Temporary

Seasonal

Are you able to meet attendance requirements of the position? ______

Yes

No

Have you ever been convicted of, plead guilty or no contest to any crime, excluding minor traffic violations? _____ Yes No If yes, please explain ________________________________________________________ CONVICTION WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. EACH INSTANCE WILL BE CONSIDERED IN RELATION TO THE POSITION FOR WHICH YOU ARE APPLYING.

Driver’s License number if driving is an essential job function _____________________________


Employment History Provide the following information for your past four (4) employers, assignments or volunteer activities, starting with the most recent.

Employer’s name and address ____________________________________________________ Length of employment __________ From: ______/________

To: ______/_______

Reason for leaving ______________________________________________________________ Position (job title and classification) _________________________________________________ Salary:--------- Beginning _______________________ Ending ___________________________ Duties Performed _______________________________________________________________

Employer’s name and address ____________________________________________________ Length of employment __________ From: ______/________

To: ______/_______

Reason for leaving ______________________________________________________________ Position (job title and classification) _________________________________________________ Salary:--------- Beginning _______________________ Ending ___________________________ Duties Performed _______________________________________________________________

Employer’s name and address ____________________________________________________ Length of employment __________ From: ______/________

To: ______/_______

Reason for leaving ______________________________________________________________ Position (job title and classification) _________________________________________________ Salary:--------- Beginning _______________________ Ending ___________________________ Duties Performed _______________________________________________________________ Employer’s name and address ____________________________________________________ Length of employment __________ From: ______/________

To: ______/_______

Reason for leaving ______________________________________________________________ Position (job title and classification) _________________________________________________ Salary:--------- Beginning _______________________ Ending ___________________________


Duties Performed _______________________________________________________________

Educational Background School

Name & Address School

of

Course of Study

No. of Years Completed

Diploma/Degree

High School Undergraduate College Graduate/Professional Other (Specify)

References Name

Telephone (

)

(

)

(

)

Years Known

APPLICANT’S STATEMENT I certify that answers given herein are true and complete. 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 as to whether or not applications are being accepted at that 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 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 conduct 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 regulations of the Employer. ____________________________________

_________________


Signature of Applicant

Date


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