1 OF 6 POST OFFICE BOX 9 ● UNION CITY, TENNESSEE 38281 ● 731.885. 1341 APPLICATION FOR EMPLOYMENT THE CITY OF UNION CITY IS AN EQUAL OPPORTUNITY EMPLOYER and does not discriminate on the basis of race, sex, color, religion, national origin, age, disability or veteran status in employment opportunities and benefits. Overview of the hiring and employment process: This Application is but one part of the hiring and employment process. Other parts may include an interview, an employment examination or test, and a demonstration of an ability to perform the essential functions of the job. If you need an accommodation in order to complete any part of the hiring and emplo yment process, please call the following number: 731 -885-1341 Prior to completing this Application be sure to read the JOB DESCRIPTION of the position for which you are applying. As you complete the Application, please keep the following in mind : All applications for employment are a matter of public record We reserve the right to check all information for accuracy and completeness If you need accommodation in order to complete this Application, please notify the municipality GENERAL INFORMATION (Please Print) Name: Date: Position Desired: Department: Are You Applying For: Fulltime Part time Seasonal IF PART TIME, WHAT DAYS/HOURS ARE YOU AVAILABLE: HAVE YOU EVER BEEN EMPLOYED BY THE CITY? YES NO If so, please indicate position, department and dates of employment. 2 OF 6 POST OFFICE BOX 9 ● UNION CITY, TENNESSEE 38281 ● 731.885. 1341 BASED ON THE JOB DESCRIPTION OF THE POSITION FOR WHICH YOU ARE APPLYING: ARE YOU ABLE TO PERFORM THE ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU HAVE APPLIED? _____ Yes _____ No (Note: you may be asked later to demonstrate your ability to perform the essential functions) PERSONAL DATA Name SOC. SEC.# last first middle Address number street city state zip code Telephone Number: Business Number: Do you have the Legal right to work in the US ? (circle) Yes No Are you over the age of 18? (circle) Yes No Have you ever been convicted of a felony?* (circle) Yes No (* note: this may be relevant if job -related, but does not bar you from employment) If yes, please explain: Driver’s License Number (if required by job) EDUCATION AND TRAINING High School Attended: city state College / University Trade / Business School City / State Zip Code Degree Earned Major Area of Study 3 OF 6 POST OFFICE BOX 9 ● UNION CITY, TENNESSEE 38281 ● 731.885. 1341 Education and Training Continued … Other Training Received ( special courses, work training programs, armed forces training, etc … ) Special Qualifications and Skills ( license, skills with machines, patents, inventions, publications ) EMPLOYMENT RECORD List below all present and past employment information and/or substantive volunteer work beginning with the most recent position and ending with your first, if appropriate. Take time to fill in these blocks carefully, your qualifications depend in a large part on your employment history. Indicate if you are now unemployed or if you have never been employed. May inquiries be made of your present employer regarding your qualifications and record of employment? ( A “no” will not affect your consideration for employment. ) ___ Yes ___ No Continued on next page 4 OF 6 POST OFFICE BOX 9 ● UNION CITY, TENNESSEE 38281 ● 731.885. 1341 Employment Continued … Employer: Address: City/State/Zip Code: Title of Position: Duties and Responsibilities: Employment Dates: From To Salary History: Starting Ending Employment Continued … Supervisor: Phone# Reason for Leaving: Employer: Address: City/State/Zip Code: Title of Position: Duties and Responsibilities: Employment Dates: From To Salary History: Starting Ending Supervisor: Phone# Reason for Leaving: 5 OF 6 POST OFFICE BOX 9 ● UNION CITY, TENNESSEE 38281 ● 731.885. 1341 Employment Continued … Employer: Address: City/State/Zip Code: Title of Position: Duties and Responsibilities: Employment Dates: From To Salary History: Starting Ending Supervisor: Phone# Reason for Leaving: Employer: Address: City/State/Zip Code: Title of Position: Duties and Responsibilities: Employment Dates: From To Salary History: Starting Ending Supervisor: Phone# Reason for Leaving: 6 OF 6 POST OFFICE BOX 9 ● UNION CITY, TENNESSEE 38281 ● 731.885. 1341 Employment Continued … Have you any relative, either blood or by marriage, working for the City of Union City ___ Yes ___ No If so, give names and relationship: REFERENCES PLEASE LIST THREE PERSONS, OTHER THAN RELATIVES OR FORMER EMPLOYERS WHO HAVE KNOWLEDGE OF YOUR CHARACTER AND/OR ABILITIES. NAME MAILING ADDRESS (number, street, city, state) YEARS KNOWN PHONE# *** IMPORTANT *** I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I understand that falsified information or significant omissions may disqualify me and my application from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I authorize persons, schools, my current employer (if applicable), and previous employers and organizations named in thi s application (and accompanying resume, if any ) to provide any information orally and/or in writing that may be requested to arrive at an employment decision and waive any right of privilege, privacy and/or confidentiality I may have in this information. Applicant’s Signature Date