Employment Application

  • Personal Information:

  • Position Applying For:

  • (Federal law requires proof of identity and employment authorization for all new employees.)
  • StateClass Type 
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  • Education/Training:

  • High SchoolLocationDates Attended (From/To) 
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  • Diploma/Degree & MajorGraduated? 
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  • CollegeLocationDates Attended (From/To) 
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  • Diploma/Degree & MajorGraduated? 
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  • Other (Business, Vocational, Military)LocationDates Attended (From/To) 
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  • Diploma/Degree & MajorGraduated? 
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  • Employment History

    Please start with the most recent, ending with age 18, excluding part-time positions held while obtaining higher education.
  • Technology Skills

    List all skills & software applications you have experience using.
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  • Explain your internet skills, including email usage.
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  • Personal References

    Please list the names of three (3) persons NOT related to you by blood or marriage.
  • Please explain
  • Certification

  • I certify that all answers and statements on this application are true and complete to the best of my knowledge. I understand that should an investigation disclose untruthful or misleading answers, my application may be rejected, my name removed from consideration, or my employment may be terminated. I understand and agree that, if hired, my employment is for no definite period and either City of Walthourville or I may terminate our relationship at any time, and that this employment application does not constitute an employment contract.
  • Typing your name below will serve as your signature.
  • Authorization for Release of Personal Information

  • As an applicant for employment with the City of Walthourville, I do hereby authorize a review of and full disclosure of all records or information concerning myself to any duly authorized agent of the City of Walthourville, whether the said records are of a public, private, or confidential nature. The intent of the authorization is to give consent for full and complete disclosure of all records and information of educational institutions; employment and pre-employment records, including background reports, efficiency ratings, complaints or grievances filed by or against me, either criminal or civil, in which I have, or have had any interest or involvement. I understand that any information obtained during any personal history background investigation which is developed directly or indirectly, in whole or in part, upon this authorization will be considered in determining my suitability for employment by the City of Walthourville. I hereby agree that any person(s) or entities who may furnish such information concerning me shall not be held liable for providing this information; and I do hereby release said person(s) and entities from any and all liability which may be incurred as a result of furnishing such information. I further authorize that a photocopy of this signed release form will be valid as an original thereof, even though the said photocopy does not contain an original writing of my signature.
  • Typing your name below will serve as your signature.
  • Typing your name below will serve as your signature.
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  • Applicant Data Record

  • Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap. As employers/government contractors, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements , please fill our the Applicant Data Record. We appreciate your cooperation. This data so for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment.
  • Government agencies require periodic reports on the sex,ethnicity, handicapped and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information about a handicap is voluntary.
  • This field is for validation purposes and should be left unchanged.