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Personal Information

First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
Have you been convicted of a felony in the last seven (7) years?*
1. Yes
1. No
A "yes" answer will not automatically disqualify you from employment. We will consider the nature of the offense, and the job for which you are applying, for job-related purposes only, and only to the extent permitted by applicable law.
Please Explain*
Are you eligible to work in the United States?*
1. Yes
1. No
Do you have a current driver's license?*
1. Yes
1. No
Proof will be required.
State*
Class*
Driver's License Number*
Expiration Date*
Expiration Date
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Position Information

Which position are you applying for?*
Type of employment desired*
1. Full Time
1. Part Time
1. Shift Work
1. Seasonal
Please check all that apply.
On what date would you be available for work?*
On what date would you be available for work?
Are you on a lay-off and subject to recall?*
1. Yes
1. No
Do you have a relative working for the City of Altus?*
1. Yes
1. No
Name of Relative*
How are you Related?*
How did you hear about the position?*
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Education

High School
Address
College
Address
Degree
Other
Address
Degree
Do you possess a high school diploma or G.E.D. equivalent?*
1. Yes
1. No
Are you currenty a student in the high school listed above?*
1. Yes
1. No
Honors Received
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Employment History

(From Most Recent)
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for Leaving
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for Leaving
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for Leaving
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References

Please list three professional references.
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
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Disclaimer & Signature

Please summarize skills, qualifications, certifications or licenses you may have that meet the qualifications for the job.
After reviewing the job description, can you perform the essential job functions with or without accommodations?*
1. Yes
1. No
Would you be willing to demonstrate how you would do the essential job functions with or without reasonable accommodations?*
1. Yes
1. No
List languages, other than English, that you speak proficiently, including communicating with the deaf.
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I certify that answers given herein are true and complete to the best of my knowledge. I understand that false or misleading statements/answers will disqualify me from employment consideration.

The background information supplied by an applicant for an open position will be checked. This check will cover the accuracy of the data furnished and the past performance record of the candidate. I hereby authorize the City of Altus to investigate all statements contained in this application and verify the facts claimed by me on this application. I understand that such information is confidential, and the City cannot reveal the reason for rejection.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the City.

I further understand and agree that my employment with the City of Altus does not constitute anemployment contract and that I may resign my position and voluntary leave employment, or my employment may be terminated at any time and for any reason.

I hereby grant permission to the City of Altus to investigate and verify any of the information included in this application, and I agree to submit to a drug test and medical examination, as required.
Applicant Signature*

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Email address

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