Date of application * Last name * First name * M.I. * Street address * Apartment / Unit # * Phone * Email * Secondary phone * Social Security Number * If hired, date available to start * Position(s) you are applying for * Minimum salary / Wage expected * Are you willing to work weekends? * Are you willing to work on Holidays? * Are you willing to work Overtime? What days/hours are you available to work? * Are you at least 18 years old? * Have you ever applied with the City of Nash before? * If yes, when (approximate mo./year) Have you ever worked for the City of Nash? * If yes, when? Title? Only US citizens or aliens who have a legal right to work in the US are eligible for employment. Can you, upon employment, provide genuine documentation establishing your identity and eligibility to be legally employed in the United States: * Are you related to any City of Nash employee? * If yes, please list name and relationship: EDUCATION: Check the highest level of education attained (ELEMENTARY): Name of High School attended Location Did you receive a diploma? If no, are you currently attending High School? Please list degree(s) and any major(s)/minor(s) achieved: Name of Trade/Business/Other school: Location Field of study List any name(s) used that is different than in this application SKILLS AND EXPERIENCE (Please list any special qualifications, training, education, skills, or experience that you feel warrant consideration by the City of Nash.) BACKGROUND (A conviction record will not necessarily bar employment. Factors such as age, time of offense, seriousness and nature of the violation and rehabilitation will be considered. In answering the questions in this section, you are not required to, nor should you, respond with any convictions which have been expunged, or convictions in cases wherein the records have been sealed.) Have you ever been convicted of, or plead guilty or Nolo Contendere (no contest), to any crime other than a minor traffic violation? NOTE: A DUI or DWI is NOT a minor traffic violation: * Please describe all convictions. Include type of crime(s), date of conviction(s) and whether the offense(s) was a misdemeanor or felony: Are you now under indictment for any crime for which you have been charged but have not been convicted: DRIVER’S LICENSE (Complete this section if the job you are applying for requires driving or operating mobile equipment.) Driver's License Number: State issued Expiration date BOND COVERAGE (Bond Coverage is used to manage exposures, such as employee dishonesty, fraudulent acts, and other risks.) Have you ever had any bond coverage modified, revoked, or declined: ESSENTIAL JOB FUNCTIONS. The Americans with Disability Act prohibits discrimination against qualified individuals with a disability, a record of a disability, or a perceived disability. There are a variety of essential functions of the job that will be required to perform. Are you able to perform all functions of the position you are applying for with or without a reasonable accommodation: Please describe which tasks, if any, you will need an accommodation to perform, and explain what type of accommodation you will need. (If you have any questions regarding the functions of the position please ask for clarification before answering this question.): Previous Employment – (List in order, most recent or precent employer should be listed first.) *
Phone Address Supervisor Job title Starting salary Ending salary Briefly describe duties: From To Reason for leaving 2. Company Phone Address Supervisor Job title Starting salary Ending salary Briefly describe duties: From To Reason for leaving 3. Company Phone Address Supervisor Job title Starting salary Ending salary Briefly describe duties: From To Reason for leaving May we contact all the above employers for a reference? If No, tell us which employers not to contact and why: Are you currently employed? If yes, why are you considering leaving: Have you ever been discharged or asked to resign from any position: If Yes, please describe the reason: Why are you seeking a new position at this time? Have you missed work or school within the last year other than approved vacation, sick or disability leave? If Yes, how many days Please describe: Consistent attendance and punctuality are essential requirements of every job at the City of Nash. Is there anything which would interfere with your regular attendance and punctuality if you are offered a job with the City of Nash: If Yes, please explain: DISCLOSURE RELEASE. - In connection with my application for employment with the City of Nash, I understand that consumer reports which may contain public record information may be requested. These reports may include the following type of information: names and dates if employment, reason for termination of employment, work experience, etc. I further understand that such records may contain public record information concerning my driving record, credit, bankruptcy proceedings, criminal records, etc., from federal, state, and other agencies which maintain such records. I have the right, upon written request, to receive a written description of the nature and scope of the investigation requested and a written summary of my rights under the Fair Credit Reporting Act. I authorize, without reservation, any person or entity contacted by the City of Nash or its agent or agents to furnish the above-stated information, and I release any such person or entity from any liability for furnishing such information. *
Date * DISCLAIMER AND SIGNATURE
The City of Nash does not discriminate in hiring on basis of race, color, religion, sex, national origin, disability, age, or any other characteristic
protected by law. This application does not intend to ask questions that would provide information that could be used for discrimination.
By signing your name below, you give the City of Nash the right to contact and obtain information from all references, employers, educational
institutions and to otherwise verify the accuracy of the information contained in this application. You certify that all answers given are true, accurate
and complete. You understand that the falsification, misrepresentation, or omission of fact on this application (or any other accompanying or required
documents) will be cause for denial of employment or immediate termination of employment regardless of when or how discovered.
You also authorize the City of Nash to conduct a background investigation, which may or may not include contacting past employers regarding your
employment and reason for leaving. You authorize the City of Nash to conduct criminal history and bond coverage inquires. By signing below, you
hereby release from liability the City of Nash and its representatives for seeking, gathering, and using such information and all other persons,
corporations, or organizations for furnishing such information.
Completing an application does not imply that you will be offered employment. You understand that nothing contained in this application or any
information gained or discussed during the interview process creates an employment contract between you and the City of Nash. You understand that
if you are employed, such employment is for an indefinite period of time and the City of Nash may change wages, benefits, and conditions at any
time. You understand that your employment is at will. No individual with the City of Nash is authorized to change the employment-
Signature * Date *