Today's Date
 

Position Applied For

Name (Last, First, Middle)

Social Security Number

Address

City / State / Zip

E-Mail Address

Phone (Including area code)

CITY OF DUNCANVILLE

Have you been employed here before?  YES   NO

If yes, when:

Do you have relatives employed by the City of Duncanville?  YES   NO

If yes, name:

When can you start if accepted?

EDUCATION - PERSONAL HISTORY

Are you a high school graduate?  YES   NO

If no, do you have a GED? YES   NO

Please indicated highest grade completed: 6   7   8   9   10   11   12   FR   SO   JR   SR

College attended:

Major:

Degree:

Please list all trade schools, military schooling, business colleges, etc:

Please list special qualifications or skills you possess, to be considered, which qualify you for the position applied for:

Have you ever been convicted of any felony or misdemeanor offense, including traffic violations? YES  NO
If yes, explain in detail, showing date, charge, place and action taken:

Note: A conviction does not mean you cannot be appointed. Give all the facts.

Have you been fired or asked to resign from any job in the last five years? YES NO
If yes, please explain:

EMPLOYMENT HISTORY

Beginning with the most recent, list the last four jobs you held (up to the last ten years) including present employer. Include military and specifically describe various duties performed at each job.

EMPLOYER #1

Employer

Employer Address

Employer Phone #

Type of Business

Name & Title of Supervisor

Employment Dates (From / To)

Starting / Ending Salary

Reason for Leaving

Your Title

Describe Your Duties

Are you eligible for rehire: yes no

EMPLOYER #2

Employer

Employer Address

Employer Phone #

Type of Business

Name & Title of Supervisor

Employment Dates (From / To)

Starting / Ending Salary

Reason for Leaving

Your Title

Describe Your Duties

Are you eligible for rehire: yes no

EMPLOYER #3

Employer

Employer Address

Employer Phone #

Type of Business

Name & Title of Supervisor

Employment Dates (From / To)

Starting / Ending Salary

Reason for Leaving

Your Title

Describe Your Duties

Are you eligible for rehire: yes no

EMPLOYER #4

Employer

Employer Address

Employer Phone #

Type of Business

Name & Title of Supervisor

Employment Dates (From / To)

Starting / Ending Salary

Reason for Leaving

Your Title

Describe Your Duties

Are you eligible for rehire: yes no

PLEASE READ CAREFULLY

I represent and warrant that the answers I have given are complete and true. And further, I expressly request former employers and any persons who may have information concerning me to furnish such information to the City of Duncanville officials, and I agree to hold such persons harmless, and do hereby release them from any liability for damages of any nature whatsoever for furnishing such information.

I further understand that omission or false statement on this application and/or any future stage of the application process shall be sufficient cause for rejection of employment or dismissal at any time.

I hereby certify that I have read all instructions and advisories and agree to all statements and stipulations.

__________________________________________________________________________________________________
Signature                                                                                                           Date

REQUIRED EEOC INFORMATION

It is the policy of the City of Duncanville not to discriminate against any person on the basis or race, color, religion, sex, age, national origin or disability.

The following data will not remain attached to your application and is not used in any way in the selection process. It will be maintained in a separate file in compliance with federal law.

Today's Date
 

Position Applied For

Name (Last, First, Middle)

Social Security Number

Check One: Male   Female

Referral Source: Advertisement   Internet   Friend   Relative   Walk-in   Employment Agency   Other

Check one of the following: White  Black Hispanic Asian or Pacific Islander American Indian or Alaska Native

Check if applicable: Vietnam Era Veteran  Disabled Veteran Person with a Disability

APPLICATION FILING INSTRUCTIONS

Due to possible security risks in e-mail transmission of confidential information, the City of Duncanville does not allow e-mail transmission of employment applications. When you have completed the application, please print a hard copy of all pages, sign and mail it to: