Application for Employment First Name *Middle NameLast Name *Street Address *City *State/Province *ZIP / Postal Code *Home/Cell Number *Other Contact NumberSocial Security Number *Are you eligible to work in the United States? *YesNoPosition Applying For: *Salary Desired: *Date you can start: *Are you employed now? *YesNoIf so, may we inquire of your present employer?YesNoHave you ever applied to this company before? *YesNoIf Yes, please provide approximate date when.If required for position, do you have a valid driver's license? *YesNoIf Yes, please provide the State of Issuance and the Driver's License Number. *EducationName of High School Attended:Did you graduate from high school or later received a GED?Four year graduate diplomaGEDDate when received diploma or GED.Name of College Attended:Degree achieved in college?2 year Associate Degree4 year Bachelor DegreeAttended some college courses, but no degree Date when completed degree in college or last date attended a college course.Name of any other school attended:Course or degree achieved in other school?Date when completed degree or courses in other school.Skills that may be relevant to the position you are applying for.Work ExperienceBegin with your current or most recent employer.Name of Employer:Position:Date began at employer:Date ended at employer :If still employed at this employer then put today's date.Salary:Reason for leaving:Name of Employer:Position:Date began at employer:Date ended at employer :If still employed at this employer then put today's date.Salary:Reason for leaving:Name of Employer:Position:Date began at employer:Date ended at employer :If still employed at this employer then put today's date.Salary:Reason for leaving:ReferencesProvide at least three persons not related to you.Name of reference: *Address & number of reference: *Occupation of Reference: *Years the reference have known you: *Name of reference: *Address & number of reference: *Occupation of Reference: *Years the reference have known you: *Name of reference: *Address & number of reference: *Occupation of Reference: *Years the reference have known you: *PLEASE READ CAREFULLY AND CHECK THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION *I certify that the information on this application is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Prestonsburg City's Utilities Commission to investigate, without liability, all statements contained in this application. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of Prestonsburg City's Utilities Commission serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, and to comply with company and departmental regulations.Send Message
