PERSONAL INFORMATION
If Yes, Date
If Yes, Date
If yes, please explain
If yes, list names
If yes, explain and give dates
AN EQUAL OPPORTUNITY EMPLOYER
If yes, what was your Branch of U.S. military service?
What language(s) do you speak, read and/or write?
Language 1
Language
Language 2
Language
Language 3
Language
List professional, trade, business or civic activities and office held. (Exclude groups which indicate race, color, religion, sex or national origin):
ADD LANGUAGE
REFERENCES
Give name, address, email address and phone number of three references not related to you:
Reference 1
Reference 2
Reference 3
Phone Number
ADD REFERENCE
EMPLOYMENT HISTORY
List each job held. Start with your Present or most recent job. Do not put "see resume" or a similar statement in the boxes; you should provide all requested information.
EDUCATION
Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.
School 1
Name
Location
Degree Received
Subjects Studied/Major
Describe Specialized Training, Apprenticeship, Skills, and ExtraCurricular Activities:
School 2
Name
Location
Degree Received
Subjects Studied/Major
Describe Specialized Training, Apprenticeship, Skills, and ExtraCurricular Activities:
School 3
Name
Location
Degree Received
Subjects Studied/Major
Describe Specialized Training, Apprenticeship, Skills, and ExtraCurricular Activities:
School 4
Name
Location
Degree Received
Subjects Studied/Major
Describe Specialized Training, Apprenticeship, Skills, and ExtraCurricular Activities:
School 5
Name
Location
Degree Received
Subjects Studied/Major
Describe Specialized Training, Apprenticeship, Skills, and ExtraCurricular Activities:
ADD SCHOOL
Honors Received
State any additional information you feel may be helpful to us in considering your application:
Summarize special skills and qualification acquired from employment or other experience:
List any software and/or office equipment with which you are proficient:
List any specialized licenses you are qualified with or any heavy equipment you are able to operate (i.e. have CDL, etc.):
PUBLIC SAFETY
Driver's License No:
* State Issued
* Number
* Expiration Date
If yes, Dates, Locations
If yes, Dates, Locations
If yes, Dates, Locations
If yes, explain
If yes, Dates, Locations
If yes, list offenses and dates
If yes, list offenses and dates
If yes, explain
If yes, explain
If yes, explain
AUTHORIZATION
By signing here, I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I also authorize a representative of the City of Dalton to check my references and past employers and agree to hold harmless anyone providing reference information. In the event of employment, I understand that false or misleading information given in my application and/or interview(s) may result in discharge. I hereby give my consent to a urine drug screen. This lab exam is performed as a condition of employment. I understand, also, that I am required to abide by all rules and regulations of the City of Dalton. I also understand that my employment is at-will and both I and/or my employer may choose to terminate my employment at any time. The City's policies do not create a property right of employment. This application may remain active for 90 days.
I understand that all applicants are required to submit to a polygraph examination before being hired. I also understand that if I accept employment with the Dalton Fire or Police Department, I am, by signing this application, agreeing to voluntarily submit to future polygraph examinations at any time after I am hired, upon the request of the department as part of an internal investigation; and
I understand the City of Dalton prohibits smoking of cigarettes or other tobacco products in any enclosed building space owned or leased by the city. I further understand that smoking is prohibited in a city-owned or leased vehicle where at least one occupant of said vehicle is a non-smoker. I also understand that being a smoker will not disqualify me from being employed by the city; and
I hereby give my consent to a urine drug screen. This lab exam is performed as a condition of employment. I also understand that the cost of this exam will be borne by The City of Dalton. I hereby authorize the release of the results of the examination to Dalton Fire or Police Department. This release also applies to all doctors and laboratories utilized in the course of the exam.
* Signature (type name)
