* = Required fields

General Information

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* Position:

How did you learn about this job opening? Website Newspaper Other

* Date available for work: Desired Salary:

Personal Information

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* First Name: Middle Name: * Last Name:

* Street Address:

* City: * State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY * Zip Code:

* Phone Number(s):

Last 4 Digits of your Social Security Number:

* Driver's License Number: * State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY * Expiration Date:

Please enter your e-mail address if you would like to receive a copy of the submitted application:

Education and Training

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	* High School	Trade or Business School	College/University	Graduate/Professional
School Name and address
Years Completed	9 10 11 12	1 2 3 4	1 2 3 4	1 2 3 4
Diploma/Degree	Diploma GED Uncompleted
Course of Study

Special Training

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List training programs or courses you have received which would qualify you for the job for which you are applying.


Military Training

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Describe any job-related training received in the United States Armed Forces.


Certifications/Licenses

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List any certifications / licenses that you have obtained that pertain to the position for which you are applying.


Professional, Trade, Business or Civic Activities and Offices Held

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You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or any other protected status.


Computer Software/Hardware Skills

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List any computer software and/or hardware and other office equipment you are comfortable using.

Employment History

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List your employment history from your current or recent employer to past employers.

1. Employer (Current or Recent)

• * Name:
• Address:
• * Phone:
• * Job Title:
• Supervisor:
• * Date Employed From:
• * Date Employed To:
• Starting Hourly Rate/Salary:
• Final Hourly Rate/Salary:
• * Reason for Leaving:
• * Work Performed:

2. Employer

• Name:
• Address:
• Phone:
• Job Title:
• Supervisor:
• Date Employed From:
• Date Employed To:
• Starting Hourly Rate/Salary:
• Final Hourly Rate/Salary:
• Reason for Leaving:
• Work Performed:

3. Employer

• Name:
• Address:
• Phone:
• Job Title:
• Supervisor:
• Date Employed From:
• Date Employed To:
• Starting Hourly Rate/Salary:
• Final Hourly Rate/Salary:
• Reason for Leaving:
• Work Performed:

4. Employer

• Name:
• Address:
• Phone:
• Job Title:
• Supervisor:
• Date Employed From:
• Date Employed To:
• Starting Hourly Rate/Salary:
• Final Hourly Rate/Salary:
• Reason for Leaving:
• Work Performed:

Additional Information

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Have you ever filed an application with the City of The Colony before?	YesNo
If Yes, give date:
Have you ever been employed with the City of The Colony before?	YesNo
* If you are under 18 years of age, can you provide required proof of eligibility to work?	YesNo
* Are you related to any person employed by the City of The Colony?	YesNo
If Yes, give name and department:
* Are you currently employed?	YesNo
* If Yes, may we contact your employer?	YesNo
* Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?	YesNo
(Proof of citizenship or Immigration Status will be required upon employment)
Can you travel if the job requires it?	YesNo
* Are you available to work:	Full-Time Part-Time Temporary
* Have you been convicted of a felony in the last five (5) years?	YesNo

If Yes, complete the following. Send additional information if necessary.
(Note: A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.)

Charge:
Date:
Location:

IMPORTANT INFORMATION: Do not answer the following question unless you have been informed about the requirements of the job or have reviewed the job description for the position for which you are applying:


* Can you perform the essential functions of the job, for which you are applying, either with or without reasonable accomodations?
YesNo

References

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Please list three references, excluding relatives:

Reference 1

• * Name:
• * Address:
• * Reference Type: Personal Professional
• * Phone Number:

Reference 2

• * Name:
• * Address:
• * Reference Type: Personal Professional
• * Phone Number:

Reference 3

• * Name:
• * Address:
• * Reference Type: Personal Professional
• * Phone Number:

Disclosures

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CITY OF THE COLONY
PRE-EMPLOYMENT/EMPLOYMENT INQUIRY RELEASE

In connection with my application for employment with the City of The Colony, I understand that inquiries will be made concerning my employment, criminal, and driving records.  I hereby authorize all former employers and all other public and private concerns, including (but not limited to) consumer reporting agencies and similar entities, to release any and all information maintained by any such employer, agency, or entity concerning my personal history.

I voluntarily agree to submit to drug screening as a condition of employment within 48 hours from the receipt of the job offer.  I understand I have the right to refuse to submit to such screening, however, I also understand that such refusal will be treated as a positive result, and I will be denied employment with the City of The Colony.

I understand if I receive a conditional offer of employment, the offer is contingent on my successfully completing and/or passing the aforementioned checks and screening.  I understand if employment with the City of The Colony is denied because of information contained in a consumer report obtained from a reporting agency, I will be entitled to receive from the City of The Colony only the name and address from the reporting agency from which the report was obtained.

I hereby understand and acknowledge that unless otherwise defined by applicable law, any employment relationship with the City of The Colony is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employees at any time with or without cause.

This authorization shall remain in effect over the course of my employment.  Reports may be ordered periodically during the course of my employment.

In consideration of the City of The Colony’s acceptance and consideration of my application for employment, I hereby, and on behalf of my heirs, agents, executors, administrators, and assignees, release and forever discharge the City of The Colony and all affiliated entities from all claims, demands, damages, actions and causes of action pertaining to or arising out of the inquiries made into my personal history, and release and forever discharge all former employers from all liability arising out of disclosure to the City of information pertaining to my personal history, as long as the disclosure and use of any such materials is not done maliciously.

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 90 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.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I also understand I am required to abide by all rules and regulations of the employer.

* I have read, understand, and consent to the paragraphs above. YesNo

By entering your full name you acknowledge that you are the applicant and agree to this release. You understand that submission of this document by email, fax, web, or other electronic methods constitutes your signature and agreement of this form.

* Full Name: