CITY OF MARQUETTE EMPLOYMENT APPLICATION AN EQUAL OPPORTUNITY EMPLOYER

Transcription

1 CITY OF MARQUETTE EMPLOYMENT APPLICATION AN EQUAL OPPORTUNITY EMPLOYER Human Resource Department 300 W. Baraga Avenue Marquette, MI (906) The City of Marquette is committed to the equality of opportunity for all people. It is the official policy of the City of Marquette to provide equal employment opportunities for all individuals, on the basis of their skills, abilities and qualifications, without regard to race, color, national origin, religion, political affiliation, sex, age, disability, marital status, arrest or conviction record, sexual orientation, disabled veteran or covered veteran status, membership in the National Guard or any other reserve component of the United States or State military forces, use or nonuse of lawful products off the employer s premises during non-working hours, or any other non-merit factors, except where such factors constitute a bona fide occupational qualification. IMPORTANT: PLEASE PRINT OR TYPE DATE: NOTE: An offer of employment is contingent upon evaluation and approval of data received via background checks, drug test(s), and health screening (if required). Please answer all questions completely. Incomplete applications may be rejected. PERSONAL INFORMATION Title of Position Applied For Full-time Part-time On-call Temporary/LTE Last Name First Name Res. Phone # (Street) Bus. Phone # City, State, Zip Code Are you legally eligible for employment in the United States: Are you at least 18 years of age? Have you ever been employed by the City of Marquette? If yes, when, in what position, and in what department? It is the policy of the City of Marquette not to employ an individual if he/she would be directly supervising or receiving direct supervision from a member of his/her family. The entire Nepotism policy can be found in the City of Marquette policies, including a definition of family. List any relatives employed by the City of Marquette or serving as elected or appointed officials. How were you referred to the City of Marquette? (if an advertisement, which newspaper or publication?) Do you possess a valid driver s license? Do you possess a valid commercial driver s license? Do you have a pending criminal charge against you and/or have you ever been convicted of a crime or summary offense (not including one which has been dismissed by a court)? If yes, explain: A conviction record or pending arrest record does not constitute an automatic bar to employment and will be considered only if there is a substantial relationship to the circumstances of the particular position.

2 EDUCATION Name & Location of High School Graduate Yes Attending If you have not received a high school diploma, have you passed a high school equivalency or GED test? Location of test: TRAINING BEYOND HIGH SCHOOL: Circle the number of years completed in a Post Secondary School: College, University, or School (Name & ) Presently Attending Major Field Degree Conferred & Year GPA (1) Yes (2) Yes (3) Yes Describe any education / training you have had which is not covered above, such as correspondence courses, service schools, inservice training Please give dates. SPECIAL SKILLS & QUALIFICATIONS The following information must be provided if you are applying for positions requiring the skills found below Number of words per minute: Number of keystrokes per minute: Typing Dictation / Shorthand Data Entry Experience in transcribing mechanically-recorded material Experience using 10-key adding machine? By Touch List any additional office machines and computer software which you can operate skillfully. List current licenses or registrations as a member of a trade or profession. List memberships in professional or technical associations. EMPLOYMENT HISTORY Use additional sheets if necessary. You may attach a brief resume to further explain your qualifications; however, you must complete all the information below to be considered for a position.

3 EMPLOYMENT HISTORY (Continued) Have you ever been suspended or discharged from any position? If yes, please explain.

4 AUTHORIZATION AND CERTIFICATION Please carefully read the following statements and initial each one where indicated. If you have a question regarding any of the statements, please ask the Human Resource Manager prior to initialing and signing the application. Your initials and signature verify that you have read, understand, and agree to abide by the statements below. I hereby certify that all statements made on or in connection with my application are true, complete and correct to the best of my knowledge and belief, and I understand and agree that any misstatements or omissions of material fact subject me to disqualification or, if hired, dismissal. I authorize the City of Marquette to contact any of the persons or organizations referenced in my application materials. I also authorize any person contacted to provide to the City of Marquette any and all information regarding my employment, education, or any other information concerning any of the subjects covered by the application. I agree to execute employment records release authorization forms as may be required by the City of Marquette requesting employment records from my present and/or former employer(s). I understand that I may be required to successfully pass a drug test to gain employment or continue employment with the City of Marquette. I consent freely and voluntarily to participate in required drug test(s), at a location selected by the City of Marquette. I also consent to the release of the test(s) results to the City of Marquette. I hereby release and hold harmless the City of Marquette, its officers, agents and employees, and the laboratory, their employees, agents and contractors from any liability whatsoever, except for their negligence, arising from the drug test(s) and decisions concerning employment bases upon the results of this test(s). In addition, I understand that the City of Marquette maintains a drug-free and a smoke-free workplace. I understand that if certain positions have particular security requirements or if the City of Marquette determines there is a Bona Fide Occupational Qualification inherent in the position which requires certain information, a police background check seeking that information may be conducted prior to making a decision regarding employment. I authorize the City of Marquette, its officers, agents, and employees to conduct such a check if I am applying for one of these positions, and I release and hold harmless the City of Marquette, its officers, agents, and employees from any liability, except for its negligence, related to the performance or result of this check. If accepted for employment, I agree that my status as an employee depends upon successful performance during a probationary period and that I am an at-will employee during this probationary period. Applicant s signature Date Thank you for your interest in employment with the City of Marquette AN EQUAL OPPORTUNITY EMPLOYER

5 AFFIRMATIVE ACTION / EQUAL EMPLOYMENT OPPORTUNITY INFORMATION NAME: POSITION APPLIED FOR: DATE: The following information will be used only for research and reporting purposes for the City of Marquette and the Federal Government in accordance with applicable laws and regulations. This information is voluntary and there will be no adverse consequences for not responding. This information is confidential and is kept separate from this application. It will not be a consideration for employment. The Americans with Disabilities Act (ADA) defines an individual with a disability as one who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such an impairment, or who is regarded as having such an impairment. Based on this definition, are you an individual with a disability? SEX: AGE: Male Female Under or over ETHNIC ORIGIN: American Indian / Alaskan Native Black / African American (Not of Hispanic origin) White / Caucasian / European / North African / Middle Eastern or Indian Subcontinent Hispanic / Chicano / Puerto Rican / Mexican / Cuban / Central or South American Asian American / Pacific Islander / Far Eastern or Southeastern Asian (i.e. China, Japan, Korea, Philippine Islands, Samoa) VETERAN STATUS: n Veteran Veteran Disabled Veteran (Disability less than 30%) Special Disabled Veteran (Disability 30% or greater)