Firefighter/EMT - CERTIFIED: Job Application | City of Pikeville Employment

Employment Application

Personal Information

Incomplete information could disqualify you from further consideration. Please complete all fields

Full Name

Address

City

State

Zip Code

Email Address

Home Phone Number

Cell Phone Number

Are you legally eligible to work in the United States? (Proof of identity and eligibility will be required upon employment)

Yes

Can you work any shift?

Yes

Availability to work (check all that apply)

Full Time

Part Time

Days

Nights

Weekends

Swing Shift

Can you work overtime?

Yes

Are you willing to travel if the job requires it?

Yes

Are you able to perform the essential functions of the job for which you are applying?

If any questions as to what functions are applicable to the position for which you are applying, please see the job description

Yes

Employment Desired

Position Desired

Date available

Hourly Rate/Salary desired

Are you currently employed?

Yes

If so, may we contact your present employer?

Yes

Referral Source

How did you hear about us?

If you chose other, please specify:

Have you ever worked for this company before?

Yes

If yes, when?

Job Title

Do you know anyone who works for the City of Pikeville?

Yes

If yes, who?

Education

High School Name & Location

Years completed

College or University Name & Location

Years completed

Degrees received

Course of study

Trade, Business or Technical School Name & Location

Years completed

Degrees received

Course of study

Have you completed any special courses, seminars, and/or training directly related to the position for which you are applying?

Yes

If yes, please describe:

Employment History

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Employers
From To Employer Name Employer Phone Number Job Title Immediate Supervisor & Title Address Employer City/State Employer Zip Summarize the nature of work performed and job responsibilities: Reason for leaving:

Have you ever been terminated or asked to resign by an employer?

Yes

If yes, please provide company names and details:

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, please explain:

Computer Skills (please describe):

References

Please give the names of three persons not related to you or former employers, whom you have known at least three (3) years.

Reference #1: Full Name

Company/Occupation

Address

City/State

Zip Code

Phone Number

Email Address

Years Acquainted

Reference #2: Full Name

Company/Occupation

Address

City/State

Zip Code

Phone Number

Email Address

Years Acquainted

Reference #3: Full Name

Company/Occupation

Address

City/State

Zip Code

Phone Number

Email Address

Years Acquainted

Please Read Carefully Before Signing.

The city is an equal opportunity employer. It is the city’s policy to afford equal employment opportunity to all qualified persons regardless of race, color, religion, age, sex, sexual orientation, gender identity, pregnancy, childbirth, pregnancy/child birth related medical conditions, genetic makeup, national origin, disability, veteran or family status, an individual’s status as a smoker or nonsmoker, genetic makeup or any other status or condition protected by applicable local, state or federal laws, except where a bona fide occupational qualification applies.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for City of Pikeville to hire me. If I am hired, I understand that either the City of Pikeville or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of City of Pikeville has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to City of Pikeville true and complete information on this application. No requested information has been concealed. I authorize the City of Pikeville to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

To expedite the employment process do you agree to a background check for the pre-employment process?*

Yes

Signature:

Date:

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE SIGNED/DATED ABOVE

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The City That Moves Mountains

Employment Application

Personal Information

Employment Desired

Referral Source

Education

Employment History

References

Please Read Carefully Before Signing.

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE SIGNED/DATED ABOVE