Employment Application

Application for Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, martial or veteran status, sexual orientation, or any other legally protected status.

Applicant Information

Revised January 2015

Position Applying For(Required)

Date(Required)

Name(Required)

First Middle Initial Last

Address(Required)

Street Address Apartment/Unit # City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

If you are under 18 years of age; Can you provide required proof of your eligibility to work?(Required)

Yes

Have you ever filed an application with us before?(Required)

Yes

When did you apply?(Required)

Have you ever been employed with us before?(Required)

Yes

When were you employed with us?(Required)

Start Date

Date(Required)

End Date

Do you have relatives working for the City of Shenandoah?(Required)

Yes

Please List

Name

Relation

Click the + to add more

Are you currently employed?(Required)

Yes

Where are you employed at?(Required)

May we contact your present employer?(Required)

Yes

Employer's Phone Number(Required)

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?(Required)

Yes

Proof of Citizenship or immigration status will be required upon employment

On what date would you be available to work?(Required)

Are you available to work:(Required)

Full-time

Part-time

Shift Work

Temporary

Are you currently on “lay-off” status and subject to recall?(Required)

Yes

Can you travel if a job requires it?(Required)

Yes

Have you been convicted of a felony within the last seven years?(Required)

Yes

Conviction will not necessarily disqualify an applicant from employment.

Please Explain:(Required)

Are you capable of performing in a reasonable manner the activities involved in the job or occupation for which you have applied? A description of the activities involved in such job or occupation is attached.

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Yes

Education

High School(Required)

Diploma/GED Obtained?(Required)

Yes

College

Major/Minor Area of Study:

Degree Obtained:

Other (Specify)

Major/Minor Area of Study:

Degree Obtained:

Any additional education that did not fit in above categories:

Describe any specialized training, apprenticeship skills, extra-curricular activities, machinery operation skills that are job related:(Required)

List professional, trade, business or civic activities and offices held. You may exclude organizations which indicate race, color, religion, gender, national origin, disability, or other protected status(Required)

State any additional information you feel may be helpful to us in considering your application.(Required)

If job requires, do you have appropriate valid driver’s licenses?(Required)

Yes

Veteran's Preference

Do you wish to be considered veteran status under Iowa Code 35c?(Required)

Yes

Those wishing to claim veteran’s preference must submit proof of service (DD214) and, if applicable, proof of disability.

Previous Employment

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 disability, or other protected status.

Employer(Required)

Dates Employed(Required)

From

Dates Employed(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Job Status (Pick One)(Required)

Full-time

Part-time

Hourly Rate/Salary

Starting

Hourly Rate/Salary

Final

Supervisor(Required)

Reason For Leaving(Required)

May we contact your previous supervisor for a reference?(Required)

Yes

Previous Employment Cont.

Employer

Dates Employed

From

Dates Employed

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Job Status (Pick One)

Full-time

Part-time

Hourly Rate/Salary

Starting

Hourly Rate/Salary

Final

Supervisor

Reason For Leaving

May we contact your previous supervisor for a reference?

Yes

Previous Employment Cont.

Employer

Dates Employed

From

Dates Employed

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Job Status (Pick One)

Full-time

Part-time

Hourly Rate/Salary

Starting

Hourly Rate/Salary

Final

Supervisor

Reason For Leaving

May we contact your previous supervisor for a reference?

Yes

Disclaimer and Signature

Note: All applicants will be required to pass a pre-employment physical evaluation and/or drug and alcohol screen after being offered a position and beginning as an employee of the City of Shenandoah.

Signature(Required)

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 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 information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules of the Employer.

Employment Application

Application for Employment

Applicant Information

Education

Veteran's Preference

Previous Employment

Previous Employment Cont.

Previous Employment Cont.

Disclaimer and Signature

City

Public

Amenities