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Employment Application (COPY 1)
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PERSONAL INFORMATION
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First Name
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Last Name
*
Address
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City
*
State/Province
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Postal Code
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Phone
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Email
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Driver's License Number and State
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Date of Birth
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Are you eligible to work in the United States?
Yes
No
Are you currently employed?
Yes
No
Do you have any relatives/friends employed by the City of Odessa?
Yes
No
If yes, list name(s) and relationship(s):
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Have you ever been convicted of a violation of the law other than a minor traffic violation?
Yes
No
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Are you a veteran of the Armed Forces?
Yes
No
If yes, what branch?
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Have you ever been convicted by a general court martial?
Yes
No
If yes, please provide details?
POSITION INFORMATION
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Which position are you applying for?
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Have you previously applied for employment with the City?
Yes
No
If yes, list date(s) and position(s) applied for:
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Type of employment desired
Full-time
Part-time
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Date available to begin work
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Salary desired
*
How did you learn of this position?
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List the specific expertise, skills, or experience you have that qualifies you for this position.
Upload Your Resume
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EDUCATION
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High School with Address
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Are you a High School graduate?
Yes
No
College with Address
Course or Major
Credit Hours
Degree/Certificate
Additional College(s) Attended/Degrees/Certificates
List any relevant training, special courses, work training programs, POST certifications, or military training you have received along with the number of training hours for each:
EMPLOYMENT HISTORY
Begin with your present or most recent employment. Include paid, unpaid, full-time, part-time, military, etc.
Company
Address
Start Date
End Date
Position
Supervisor
Phone Number
May we contact your supervisor?
Yes
No
Starting Salary
Ending Salary
Reason for leaving
Description of duties/responsibilities
Company
Address
Start Date
End Date
Position
Supervisor
Phone Number
May we contact your supervisor?
Yes
No
Starting Salary
Ending Salary
Reason for leaving
Description of duties/responsibilities
Company
Address
Start Date
End Date
Position
Supervisor
Phone
May we contact your supervisor?
Yes
No
Starting Salary
Ending Salary
Reason for Leaving
Description of duties/responsibilities
REFERENCES
Please list three professional references.
Full Name
Relationship
Company
Phone Number
Full Name
Relationship
Company
Phone Number
Full Name
Relationship
Company
Phone Number
DISCLAIMER AND SIGNATURE
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 the 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.
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Applicant Signature
PRE-EMPLOYMENT AUTHORIZATION AND RELEASE
I understand that in connection with my application for employment, the City of Odessa and its designated employees may perform, request, or obtain background information about me. This background check may include, but is not limited to, an inquiry into my employment history, education, general character or reputation, work experience, volunteer experience, driving, and/or criminal history.
This background check will include a search of outstanding obligations/delinquencies of City or County debts, including taxes, utilities, ambulance, special assessments, and community center fees. If the position applied for involves handling money and/or having access to monies and/or other transferable monetary instruments, my credit history may also be checked.
I understand that the City of Odessa may rely on all or any part of the information acquired pursuant to this authorization in determining whether to extend an offer of employment to me. An offer of employment may be contingent upon payment of outstanding City or County debts.
I have read this pre-employment disclosure and, by signing below, hereby authorize the City of Odessa and its designated employees to conduct a background check as described herein. I hereby release the City of Odessa and its officers, agents, elected officials and employees from any and all liability related to the procurement or disclosure of information provided by me or obtained about me in connection with my application for employment.
By signing below, I further authorize, without reservation, any party including, but not limited to, individuals, employers, consumer reporting agencies, governmental entities, law enforcement agencies, institutions and private information bureaus or repositories, to furnish any or all of the above-mentioned information to the City of Odessa, and I release and discharge from liability all individuals, companies, firms, corporations, or public agencies who release requested information pertaining to me to the City of Odessa whether verbal or written.
By typing your electronic signature in the following box you are indicating your agreement to the release above.
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Applicant Signature
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