Application for Employment: The City of Clare

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status. Please use this form to apply for employment in any of the City's departments, including the Clare Fire Department.

Personal Information

Last Name:

First Name:

Middle Name:

Address:

City:

State:

ZIP Code:

Telephone Number(s):

E-Mail Address:

Position(s) Applying For: Date of Application:

How did you learn about us?

Advertisement Relative Employment Agency Inquiry Friend
Other (please specify)

General Information

The best time to contact you at home is:

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes No

Have you ever applied with us before? Yes, date: No

Have you ever been employed with us before? Yes, date: No

Do any of your friends or relatives, other than spouse, work with the City? Yes No

Are you currently employed? Yes No

May we contact your present employer? Yes No

Are you prevented from lawfully becoming employed in this country because

of Visa or Immigration Status? Proof of citizenship or immigration status will

be required upon employment. Yes No

Date you are available for work:

What is your desired salary range?

Are you available to work:

Full-Time, 1st Shift Full-Time, 2nd Shift Full-Time, 3rd Shift

Part-Time, Mornings Part-Time, Afternoons Part-Time, Evenings

Temporarily, available to .

Are you currently on "lay-off" status and subject to recall? Yes No

Can you travel if a job requires it? Yes No

Education

	School Name and Address	Course of Study	Number of Years Completed	Did you receive a diploma?
Elementary School				Yes
High School				Yes
Undergraduate College				Yes
Graduate Professional School				Yes
Other (Specify)				Yes

Please describe any specialized training, apprenticeship, skills and extra-curricular activities.

Please describe any job-related training received in the United States Military.

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status.

1.	Employer		Dates Employed		Work Performed
	Address		From	To
	Telephone Number(s)
	Job Title	Supervisor	Hourly Rate/Salary
	Reason for Leaving		Starting	Final

2.	Employer		Dates Employed		Work Performed
	Address		From	To
	Telephone Number(s)
	Job Title	Supervisor	Hourly Rate/Salary
	Reason for Leaving		Starting	Final

3.	Employer		Dates Employed		Work Performed
	Address		From	To
	Telephone Number(s)
	Job Title	Supervisor	Hourly Rate/Salary
	Reason for Leaving		Starting	Final

4.	Employer		Dates Employed		Work Performed
	Address		From	To
	Telephone Number(s)
	Job Title	Supervisor	Hourly Rate/Salary
	Reason for Leaving		Starting	Final

Please list professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status.

Additional Information

Other Qualifications

Please summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills

Please check skills/equipment familiar with.

Terminal Spreadsheet PC/MAC Word Processing

Typewriter WPM: Shorthand WPM:

Please state any additional information you feel may be helpful to us in considering your application.

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING:

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given. Yes No

References

1. Name:	Phone #:
Address:

2. Name:	Phone #:
Address:

3. Name:	Phone #:
Address:

Applicant's Statement

Please Read Carefully: By clicking the submit button below, you are "electronically signing and dating" your application. You agree to the following:

I certify that answers given herein are true and complete.

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 45 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.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such a change is specifically acknowledged inwriting by an authorized executive of this organization.

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

Name: Date: