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Personal Information

Positions(s) Applied For:
Date
Date
How did you hear about the position?
1. Advertisement
2. Website
3. Friend/Relative
1. Walk In
2. Other
First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
Haven you ever filed an application with us before?
1. Yes
1. No
If yes, give date
Have you ever been employed with us before?*
1. Yes
1. No
If yes, give date
Are you eligible to work in the United States?*
1. Yes
1. No
Proof of citizenship or immigration status will be required upon employment.
Have you ever been convicted of a violation of the law other than a minor traffic violation?*
1. Yes
1. No
If yes, please explan
Are you available to work:
1. Full time
2. Part time
3. Temporary
Date available to start working:
Date available to start working:
The City of Eufaula is an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital status, veteran status, sexual orientation, or any other legally protected status.
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Education

High School*
City, State
Degree Received *
1. Yes
2. No
College
City, State
Degree Received
1. Yes
2. No
Type of Degree
Other
Degree
Describe any specialized training, apprenticeship, skills, and extra-curricular activities.
Describe any job-related training received in the United States military.
The City of Eufaula is an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital status, veteran status, sexual orientation, or any other legally protected status.
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Employment History

(From Most Recent)
Company*
Position*
Address
City, State
Supervisor
Phone Number
May we contact your previous supervisor for a reference?*
1. Yes
1. No
Salary
Employed From - To (Date)*
Employed From - To (Date) Start Date
—
Employed From - To (Date) End Date
Reason for leaving-if current employer, put n/a*
Responsibilities
Company*
Position*
Address
City, State
Supervisor
Phone Number
May we contact your previous supervisor for a reference?*
1. Yes
1. No
Salary
Employed From - To (Date)*
Employed From - To (Date) Start Date
—
Employed From - To (Date) End Date
Reason for leaving-if current employer, put n/a*
Responsibilities
Company*
Position*
Address
City, State
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Salary
Employed From - To (Date)
Employed From - To (Date) Start Date
—
Employed From - To (Date) End Date
Reason for leaving*
Responsibilities
The City of Eufaula is an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital status, veteran status, sexual orientation, or any other legally protected status.
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Additional Information/Other Qualifications

References

Please list three professional references.
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
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Disclaimer & 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.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the City of Eufaula is of an "at will" nature, which means that the employee may resign at any time, and the employer may terminate employee at anytime with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or conduct unless such change is specifically acknowledged in writing 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 termination. I understand, also, that I am required to abide by all rules and regulations of the employer.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking 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.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date
Date

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