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r <br /> • <br /> • <br /> CITY OF CENTERVILLE <br /> APPLICATION-FOR EMPLOYMENT <br /> PERSONAL INFORMATION DATE <br /> Name <br /> Last First Middle <br /> Present Address <br /> • Street City State Zip <br /> Permanent Address <br /> Street City State Zip <br /> Are you 18 years or older? Yes __ No i Phone Number - <br /> EMPLOYMENT DESIRED <br /> Position Date you can start Salary required <br /> Have you filed an application here before? Yes No If yes, give date <br /> Have you ever been employed here before? Yes No If yes, give date <br /> Referral Source: Ad ( specify newspaper) Walk -in _ Other <br /> Are you now employed? Yes — No _ If yes, may we contact your employer? Yes ^ No <br /> Are you available to work Full -Time Part-Time Temporary <br /> List Hours available <br /> EDUCATION Name and # of Years Diploma/ <br /> Location Attended Degree <br /> High school <br /> College/Trade <br /> Other <br /> Special Skills and Qualifications <br /> List license held relevant to employment: <br /> Type: Number: Exp. Date <br /> Type: Number: Exp. Date <br />