Laserfiche WebLink
OFFICE USE ONLY <br />DATE RECEIVED APPLICATION FOR EMPLOYMENT <br />CITY OF CENTERVILLE _______________________ <br />Interview: <br />1880 Main Street <br />Centerville, MN 55038 <br />Main: (651) 429-3232 <br />Fax: (651) 429-8629 <br />www.centervillemn.com <br />Title of Position Applying For <br />Date Available for Work Today’s Date <br />Employment Status Desired: ___Full-Time ___Part-Time ___Seasonal ___Temporary <br />Social Security Number <br />Last Name First Name Middle Name <br />(Optional) <br />Street Address City State Zip Code County <br />Email Address: <br />Home Phone: (_________) __________-____________ Are you a United States Citizen or legally eligible to work in the U.S.? <br />(If hired, you will be required to provide <br />Work Phone: (_________) __________-____________ ___Yes ___No <br />documentation that you are eligible to work in the U.S.) <br />Other: (_________) __________-____________ <br />Are you willing to work over time? ___Yes ___No <br />Are you under 18? __Yes __No If Yes, list birth date: _____/_____/____ <br />Have you been previously employed by the City of Centerville? ___Yes ___No If yes, list date(s) and position(s) held: <br />Do you have any relatives working for the City of Centerville? ___Yes ___No If Yes, list names and relationship to you: <br />Did you graduate from high school or receive a GED? ___Yes ___No High School Name & Location: ____________________ <br />______________________________________________ <br />Degree, Certificate or Credits <br />Type of SchoolName & LocationMajor <br />Earned <br />College/University <br />College/University <br />Graduate School <br />Technical/Vocational <br />Other <br />Driver’s License Number State Expiration Date Class: ____A _____B _____D _____CDL <br />List any endorsements: <br />WORK EXPERIENCE: <br />List complete employment history, beginning with most recent first. Include paid and unpaid experience. <br /> <br />