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Start with your present or most recent employer and give a complete record of all employment for the past ten 10 years include service in the armed forces if applicable. Show all periods of unemployment during the ten-year period.

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If former employers are out of business, so state. If you were in business for yourself, give nature of business and location. Be accurate. You must for all of your time during the past ten years. I certify that all the information in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I agree to cooperate in a thorough investigation of all statements made herin and other matters relating to my background and qualifications. I understand that any investigation conducted may include a request for employment and educational histories, driving record and criminal history.

I authorize any person, school, current or former employer to provide information relevant to such investigation and herby release all persons and corporations requesting or supplying such information from all liability or responsibility to me for doing so.

Positions applying for. Position 2. Position 3. How did you learn of this opening?

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Last Name. Address Line 2. Helena St. Length of time at present address. Phone .

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Are you a U. If not a U. Citizen, do you have permission to remain permanently in the U. Are you under 18 years of age? Are you able to perform the essential duties of this position? Yes No. If no, describe.

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Illness or Injury. Have you had any serious illness or injury that may affect your ability to perform any functions related to the position for which you apply? If yes, describe. Have you ever been convicted of a felony?

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If yes, list date s and state. Date Available for Employment. Have you worked for the city before?

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If yes, when? Do you have a valid Driver's ?

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If yes, list state. Driver's. Commercial Driver's ? Type of Endorsement. Select the highest grade completed 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Above. Name of high school attended and location. High School Diploma? General Equivalency Diploma G.

College 1. Name of School. of Credits or Degree Received. College 2.

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Special Skills, Training, or Knowledge. Military Service. Were you ever in the U. Armed Forces?

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If yes, give branch, dates of enlistment and discharge, and duties performed. References do not list relatives. Reference 1.

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Name and Occupation. Reference 2. Reference 3. Reference 4.

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Employment Record Start with your present or most recent employer and give a complete record of all employment for the past ten 10 years include service in the armed forces if applicable. History 1. Company and Address.

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Total Time. Salary or Wage. Position and Duties. Reason for Leaving. History 2. History 3. Please read the following I certify that all the information in this employment application is true and complete. I have read and understand, and by submitting this application, consent to these statements. The City of Huntington is an equal opportunity employer.

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If you feel you have been discriminated against in employment on the basis of age, race, sex, sexual orientation, color, religion, national origin, disability or veteran status, please report it.