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Personal Information

First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
Have you ever been convicted of a violation of the law other than a minor traffic violation?*
1. Yes
1. No
Are you eligible to work in the United States?*
1. Yes
1. No
Are you at least 18 years of age?*
1. Yes
1. No
Do you have a Valid Drivers license? If yes, what type / class?*
Have you ever filed an application or been employed here before?
1. Yes
1. No
Are you a Veteran of the U.S. Military Service?*
1. Yes
2. No
Are you claiming Veterans' Preference?
1. Yes
2. No
If you are claiming Veterans' Preference, please provide the date and type of military discharge.
Veterans Preference - Please visit our Human Resources page for more information.
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Position Information

Which position are you applying for?*
Type of employment desired*
1. Full Time
1. Part Time
1. Internship
Saraly desired*
Hours of work (per week) desired*
How did you hear about the position?*
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Education

High School
Address
College
Address
Degree
Other
Address
Degree
Please list any professional trade certifications or special training you hold, and date acquired:
List any relavent training certificates / courses you have completed. (Example - stormwater training, Microsoft Office applications, NIMS, etc.)
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Employment History

(From Most Recent)
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for leaving:
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for leaving:
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for leaving:
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References

Please list three professional references.
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
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Disclaimer & Signature

Applicant Statement of Understanding
I understand that, if hired, I will be placed on a year probation period. I further understand that if I am terminated for unsatisfactory work performance within the year probation period, the City of Callaway may seek to contest any unemployment benefit I might obtain as a result of my termintation.

I understand and agree that all policies and procedures may be modified, amended, or deleted by the employer with or without notice to me of such amendment, modification or deletion to policies and procedures whether oral or written are to be advisory only and are not interpreted as a contract of employment or to give me any right of continued employment and that my employment may be terminated at the will of either me or the City of Callaway and may be terminated without cause and with our without notice by either party. I also understand any other arrangements, agreements, or understandings regarding term of employment are hereby canceled and superceded, and that no amendmentor exceptions to this statement is valid unless in writing.

The Human Resources Office collects Social Security numbers of applicants, employees and some dependents thereof as required or permitted by law. Social Security numbers are collected to be compliant with record keeping and reporting to Federal, State, and local agencies, for establishing identities, for conducting pre-employment background screenings, and for providing employee benefit programs.
I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*

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