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<br />PlEASE READ CAREFULLY D,la Privacy "Tennesson W "olog" <br /> <br />This application IS to assist In the process of referring you to City Departments for <br />possible employment. Cedain information requested on the application is private, that IS, <br />it may be released only to you or 10 City Departments where you may be considered for . <br />employment. Names of applicants would become public when certified as eligible for appointment <br />to a vacancy or when the applicant is considered by the appOinting authority to be a finalist for a position. <br /> <br />---~----------------------------------------------------------------------------------------- <br />ARE YOU LEGAlLY <br />OBLIGED TO WHAT MAY HAPPEN IF <br />::~i~~~_Q~~~ ~~~_~~_~~~_~Q~_~~ ~~Q~~Q~_~~2____ ~QQ-QQ~~~-~~Q~~Q~_~~2 <br /> <br />NAME fo distinguish yeu from Yes Failure to provide <br />all other applicants and information ~2Y be <br />to make Pl'ocessing more cause of rejecting <br />efficient. an application. <br /> <br />51P-[[1 r,ODRESS, To be "ble to send you Yes Failure to provide <br />~;'Ol.l-!E OR [30X r.otic;'s. i;:fo,~"tio;, (;lay l-.c> <br />!IUMBER cause of rejecting <br />an application. <br /> <br />tlOHE TElEPI10NE To be able to contact you No We ~ay not be able <br />riUHBER to deterr,ine availabilit,,. to e~ploy you 1n <br />for in t e r vie.. . c e)' t Zl i n job s .. her e <br />you i1l 2. Y be r e qui red <br />to com e to}.' 0 r k 011 <br />S h 0 r:: not ice. <br /> <br />CONVICl rON RECORDS To dcter~ine w!lether we Yes We wi 11 not be able to <br /> <br />:ay :.le=~~IY ~:r~p~ ~n :a:~, d~~c~~i~I~~jons . <br /><_ p p " 1 C " <. ~ 0 r, 1 I 0,; ;' 0 '-' 1 t --l U _ r ~ ,_ .,} "- c: \. <br />and to deter.int ~hether <br />YOIJr record ~ay be jolJ- <br />reLd~t'd cOi.viction. <br /> <br />Jt.TE OF BIRTH To ide:itify you for Ho In;,!dequate identification <br />investigative purposed ll.e.}' cause rejecting <br />(Police Depzrtment of an appLication. <br />Employment Ooly) <br /> <br />'/OL~rnEE!U To 2110w LIS to identify No lio consequence <br />CO Mf/;UI-11TY Volunteer/Community Actil'ity Th:s is optional <br />,t.., C T jV 11IE S experience 'N 11 ic Ii m 2Y 2 s s is t <br />you in meeting the required <br />qualificztion fora job. <br /> <br />C~R1!FICJdE, To certify applicants for Yes Failure to provide this <br />;iEGISTRATIONS, OR positions where state law information for related <br />ICCUP/dlONAL requires appropriate positions m3)' result in <br />ICEUSES certjjicates, registrations, your rejection as an <br />or lice n s es a p plica n 1. <br /> <br />EFERENCES To allow liS to contact No No consequences. <br />people who r.now you to verify This is optional. <br />your work habits. <br /> <br />. <br /> <br />'ll_QTHER INfORMATION ON THE APPLICATION FORM IS PUBLIC, !~~!_!~~_!!_~~! BE GIV~~_!Q_~~!Q!~ <br />i OR AHY-PURPOSE------------------------------------------ ------- <br />-.-.------------- <br /> <br /> <br /> <br />--.-- <br />