here - City of Sandpoint

CITY OF SANDPOINT
EMPLOYMENT APPLICATION
An Equal Opportunity Employer
(please print neatly or type)
Instructions (required): You ma y complete th e second page or attach, and indicate that you have
attached, a copy of your résumé with the following information: (1) employment history; (2) your
highest level of education, name and location of school, degree obtained / courses of study; (3)
professional certifications or registrations; (4) military experience; and (5) three references with
addresses and phone numbers of persons who have knowledge of your character and qualifications,
not including relatives or former supervisors, listing the number of years you have known each.
POSITION APPLIED FOR: ___________________________ Today’s Date:_________________
On what date would you be available to begin work? ____________________________________________
PERSONAL INFORMATION:
Last Name
First Name
Mailing Address
City/State
Zip Code
Social Security Number
Physical Address (street address)
City/State
Zip Code
Cell Phone Number
Home Phone Number (if different from cell)
E-mail Address
Are you at least 18 years of age?
Yes
Middle Initial
DO NOT PROVIDE
AT THIS TIME
No
SPECIAL SKILLS AND TRAINING
Indicate your proficiency in performing any of the following specific tasks:
 Computer
List software/computer applications
with which you are proficient:
 Calculator
 Typing WPM:
 Filing/records management
 Carpentry
 Masonry
 Building maintenance
 Electrical
 Power tools
 Gas/diesel mechanic
 Recreation programming
 Water/Sewer Utility Work
 Irrigation
 Landscaping
 Equipment Operator
 Law Enforcement
 Communications
 Other
Thank you for your interest. This application will be kept on file only until the position for which you
have applied has been filled. A separate application must be completed for each position.
APPLICANT’S NAME:
Today’s Date:
POSITION APPLIED FOR:
Employment History (at least 10 years, if applicable; attach additional sheets if necessary)
You may attach a copy of your résumé in lieu of completing this page.
Dates of Employment
Name and Location of Employer
Position Held
Highest Level of Education Completed
Name of School
Location of School
Degree/Diploma Obtained
Professional certifications or registrations:
Military experience:
List three references, including addresses and phone numbers, who have knowledge of
your character and qualifications, not including relatives or former supervisors.
Name
Address
Phone Number
Years Known
Are you related, by blood or marriage, to a City of Sandpoint elected official or any person
currently employed by the City of Sandpoint? ___________________________________
If yes, please state name and relationship to you: ________________________________
_______________________________________________________________________
DRIVING RECORD AND CRIMINAL HISTORY REVIEW
Applicants may have to successfully pass a driving record and/or criminal history review for any criminal
convictions. In order to make proper identification for this review, additional information is necessary in
order to verify your driving records and criminal history review. This information may be provided on a
volunteer basis at the time you submit your application OR you may delay completing this section until such
time as you may be contacted for an interview. Please print.
State:
Standard Driver’s License Class:
Commercial Driver’s License Class/Type:
Number:
State:
Number:
Please list all of the cities or towns in which you have lived during the last five (5) years:
City/State:
City/State:
City/State:
City/State:
Please list any criminal offenses for which you have been convicted in the past five (5)
years:
Date:
City/State/Country:
Conviction:
I authorize the City of Sandpoint to verify this information, and I understand that any conviction not
listed which appears on a security check will automatically disqualify me on the basis of falsification
of the application. I understand that a felony conviction may or may not be grounds for disqualification,
and that each case will be judged individually.
Date:
Signature:
I understand that any willful misrepresentation or omission of facts in this employment
application may be considered cause for immediate dismissal. I authorize investigation of
all statements contained in this application as may be necessary in arriving at an
employment decision. I acknowledge that, if I am employed by the City, I will be an “at will”
employee, free to terminate my employment at any time for any reason, and the City retains
the same rights. No representative of the City has the authority to make any contrary
agreement unless it is set forth in writing and signed by a duly authorized representative of
the City.
Date:
Signature:
Return completed application to: Sandpoint City Clerk’s Office, 1123 Lake Street, Sandpoint, Idaho 83864 Phone: (208) 263‐3317 Fax: (208) 263‐3678 E‐mail: clerksoffice@ci.sandpoint.id.us THIS PAGE INTENTIONALLY LEFT BLANK
TODAY’S DATE:
FOR WHICH POSITION DID YOU APPLY?
I learned about this job opening through (check all that apply):
City Employee
Friend/Relative
__ City Employment Announcement
__ City Hall Walk-In
__ City of Sandpoint website, www.sandpointidaho.gov
__ Other website (please specify)
__ An Organization or Group (please specify)
__ Bonner County Daily Bee Newspaper Advertisement
Other Newspaper (specify name of newspaper):
__ Other Advertisement (specify publication):
__ Unsolicited mailing
__ Other means (specify):
AFFIRMATIVE ACTION DATA
It is the policy of the City of Sandpoint to provide equal opportunity in all terms, conditions, and privileges
of employment for all qualified job applicants and employees without regard to race, color, national origin,
sex, age, marital status, veteran status, or the presence of any sensory, mental or physical disability. To
help us comply with government record keeping, reporting, and other legal requirements, please complete
the affirmative action data below. PROVIDING THIS INFORMATION IS VOLUNTARY AND WILL BE
KEPT IN A CONFIDENTIAL FILE SEPARATE FROM THE APPLICATION FORM.
ETHNIC CATEGORY (Choose only one):
WHITE (not of Hispanic origin)
AFRICAN-AMERICAN (not of Hispanic origin)
HISPANIC
ASIAN OR PACIFIC ISLANDER
NATIVE AMERICAN OR ALASKAN NATIVE
SEX:
Male
Female
AGE: Are you 40 years of age or older?
Yes
VETERAN: Are you a veteran of the U.S. military service?
No
Yes
No
DISABILITY: Are you disabled? __ Yes __ No __ I do not wish to answer.
Do you require reasonable accommodation in order to perform this job? __ Yes __ No
The City of Sandpoint and USDA are Equal Opportunity Providers and Employers.
It is the policy of the City to provide equal opportunity in all terms, conditions, and privileges of employment
for all qualified job applicants and employees without regard to race, color, national origin, sex, age, marital
status, veteran status, sexual orientation, gender identity/expression, or the presence of any sensory, mental
or physical disability.