College

City

State

Did you graduate?YesNo

Degree Earned

Other certification(s)/specialized training/skills/apprenticeship(s).

 

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EMPLOYMENT EXPERIENCE

List each job held starting with your present or last job. Include military service assignments and volunteer activities. Exclude groups that indicate race, color, religion, national origin, disability, marital status, or political affiliation. Attach additional pages if necessary.

Current Employer

Employer:

Address:

Supervisor and Title:

Phone:

Your Title:

Dates of Employment: From: To:

Duties:

Full-TimePart-Time

May we contact employer? YesNo

Reason for leaving:

Previous Employer

Employer:

Address:

Supervisor and Title:

Phone:

Your Title:

Dates of Employment: From: To:

Duties:

Full-TimePart-Time

May we contact employer? YesNo

Reason for leaving:

Previous Employer

Employer:

Address:

Supervisor and Title:

Phone:

Your Title:

Dates of Employment: From: To:

Duties:

Full-TimePart-Time

May we contact employer? YesNo

Reason for leaving:

Previous Employer

Employer:

Address:

Supervisor and Title:

Phone:

Your Title:

Dates of Employment: From: To:

Duties:

Full-TimePart-Time

May we contact employer? YesNo

Reason for leaving:

 

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REFERENCES

Name:

Address:

Phone:

Email:

Relationship:

 

Name:

Address:

Phone:

Email:

Relationship:

 

Name:

Address:

Phone:

Email:

Relationship:

 

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READ BEFORE SIGNING AND SUBMITTING

I hereby certify that all statements in this application are true, accurate, and complete to the best of my knowledge. I understand that any false statements, misrepresentations, and /or omissions of facts contained in this application (or any other supplemental documentation), may cause rejection of this application or any appointment to a position to be rescinded or result in immediate discharge, irrespective of the duration of employment. I hereby authorize the City of Fulton to contact any of the employers listed to verify my employment work record.
 
Also, I understand the City of Fulton will require me, within one year of employment, to reside within thirty (30) miles beyond the nearest existing city limits within three (3) months after completing their probationary period.
 
I understand that it may be necessary for me to pass a pre-employment physical that includes a physical exam and/or drug screen. The physical will be paid for by the City and will be performed by a physician and/or medical facility designated by the City. I understand that this application is not, nor is it intended to be, a contract of employment or a guarantee of any kind.

 

Attach resume (PDF or Word Doc) (file size 5Mb or less).

 

Type Signature
 
Date:
 

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AUTHORIZATION TO RELEASE INFORMATION

As an applicant for a position with the City of Fulton, I certify that if the information given by me herein, or in a subsequent interview, is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge.
 
I authorize the use of any information in this application, or any other supplemental documentation, to verify my statements. I authorize the investigation of my past and present work, character, education, military, or police records to ascertain any and all information, which may be pertinent to my employment qualifications.
 
The release of any and all information about me is authorized, whether such information is of record or not. I do hereby release all person(s), firms, agencies, and/or companies from liability and any damage resulting from such information.
 
Type Signature
 
Date: