CITY OF BOUNTIFUL
USE TYPERWRITER OR PRINT CLEARLY IN INK, ALL APPLICATIONS WILL BE RETAINED FOR SIX MONTHS
As a means of accommodation to persons with disabilities that prevent them from completing this application, confidential assistance in filling out this application may be obtained calling (801) 298-6140.
1. List the kind of position desired. 1 ___________________ 2 _________________ 3 _________________
2. Name: First_____________________Middle ______________________Last________________________
3. Address: Street _______________________City ________________ State _______ Zip Code _________
4. Phone No. Home _______________ Bus. _______________ 5. Social Security No. ____ / ____ / _____
6. Birthday (MM/DD/YY) ____________________7. Driver's Lic. No. _____________________ State ________
8. Professional or Trade License Certificates or Registrations (Kind, No., State)
________________________________________________________________________________________
9. What is the lowest entrance salary you will accept for any position? $_______________Per Month
NOTE: You will not be interviewed for any position which the starting salary pay is less than you indicated.
10 . Have you ever been discharged or forced to resign from a position? Yes __ No__
(If yes, please explain fully on a separate sheet.)
11. Have you ever been convicted of violating any Criminal Law other than Minor Traffic Offenses? Yes __ No __
12. High School Graduate? Yes ___ No ___ (If no, circle highest year completed) 1 2 3 4 5 6 7 8 9 10 11 12
Typing Speed (rate ) ____________________
College, Business or Trade Schools Attended Name and Location (City) of School |
Amount of Credis Earned |
Degree Earned (B.S., B.A., M.A.) |
|
RETURN TO CITY OF BOUNTIFUL, CITY HALL, 790 SOUTH 100 EAST, BOUNTIFUL, UTAH 84010
Phone No. 298-6142
EQUAL OPPORTUNITY EMPLOYER
EXPERIENCE
13. Beginning with present or most recent experience, account for all employment during THE LAST 10 YEARS. If you wish to elaborate on your experience, a supplemental sheet or resume may be attached, but this section must be completed. Include military service, if applicable. Also Include non-paid (volunteer type) employment.
Firm Name _____________________________________________________ Full Time ____ Part Time ____ Volunteer ____ From _______________________ 20_______ To ________________________ 20_______ Address _________________________________________________________ Hours Worked Per Week _________________ Job Title ______________________________________________ Salary: $____________________ per ________________ Duties: ______________________________________________________________________________________________ |
Firm Name _____________________________________________________ Full Time ____ Part Time ____ Volunteer ____ From _______________________ 20_______ To ________________________ 20_______ Address _________________________________________________________ Hours Worked Per Week _________________ Job Title ______________________________________________ Salary: $____________________ per ________________ Duties: ______________________________________________________________________________________________ |
Firm Name _____________________________________________________ Full Time ____ Part Time ____ Volunteer ____ From _______________________ 20_______ To ________________________ 20_______ Address _________________________________________________________ Hours Worked Per Week _________________ Job Title ______________________________________________ Salary: $____________________ per ________________ Duties: ______________________________________________________________________________________________ |
Firm Name _____________________________________________________ Full Time ____ Part Time ____ Volunteer ____ From _______________________ 20_______ To ________________________ 20_______ Address _________________________________________________________ Hours Worked Per Week _________________ Job Title ______________________________________________ Salary: $____________________ per ________________ Duties: ______________________________________________________________________________________________ |
14. Are you legally eligible for employment in the United States? Yes ___ No ___
15. If there is any other information the applicant would like to make Bountiful City aware of, please attach it in writing to this application.
16. CERTIFICATE OF APPLICANT. (Carefully read before signing)
I authorize investigation of all statements contained in this application, an a check of my criminal history, traffic record, previous employment and educational background. I release Bountiful City and providers of information from any liability as a result of furnishing and receiving any information in this hiring process. I understand that I will be required to submit to a pre-employment drug test as a condition of employment. I certify that all information provided by me in connection with this application is rue and complete, and understand that misrepresentation or omission of facts in this application is cause for disqualification of the application and/or separation from employment.
Date __________________________ Signature of Applicant _____________________________________________