Employment Application


* required fields

Today's Date: 09/19/18
Employment Desired
Type: Full Time
Part Time / Seasonal
For each facility - please select corresponding position:
General:
Winter Sports Building:
Hillcrest Golf Course:
Two Rivers Activity Center:
Parks and Recreation Maintenance:
Have you previously worked for us?
  yes
  no
If so , when?
Position:
Supervisor:


Personal Information
Last Name: *
First Name: *
Middle Name:
Present Address: *
Present City: *
Present State: *
Present Zip: *
   
Permanent Address:
Permanent City:
Permanent State:
Permanent Zip:
   
Cell Phone: *
Home Phone:
Email: *
Are you 18 years or older? yes
no

If no, birthdate:
Are you legally eligible for employment in the United States? yes
no
   
Current Drivers License? yes
no
State Issued?
   
Has your license been revoked or suspended in the last 3 years: yes
no

If yes, when?
   
Have you ever been convicted of a crime other than a minor traffic violation or have you received a deferred imposition of sentence? yes
no
*Convictions are not an absolute bar to employment, but will be considered in relationship to the job requirements. If yes, please explain?


Education Information
SCHOOL NAME AND LOCATION OF SCHOOL COURSE OF STUDY NO. OF YEARS COMPLETED DEGREE OR DIPLOMA
High
College
College
Other
 
Military Are you claiming Veteran's Preference under ND State?
You must submit a DD214 verifying each claim.
yes
no
 
Please indicate if you currently hold any of the following:
CPR Certification Lifeguard Training
First Aid Certification WSI - Water Safety Instructor
First Aid/CPR Instructor Lifeguard Training Instructor
Please list any other certifications:


Employment History
List the last three employers, starting with the most recent.
Company Name:
Telephone:
Employed (State Month and Year)
From:
To:
Salary:
Reason for Leaving
Address:
Name of Supervisor:
Position:
May we contact? yes
no

If not, why:
 
Company Name:
Telephone:
Employed (State Month and Year)
From:
To:
Salary:
Reason for Leaving
Address:
Name of Supervisor:
Position:
May we contact? yes
no

If not, why:
 
Company Name:
Telephone:
Employed (State Month and Year)
From:
To:
Salary:
Reason for Leaving
Address:
Name of Supervisor:
Position:
May we contact? yes
no

If not, why:


Personal References
Give the names of three persons not related to you, whom you have known at least one year.
Name and Occupation Address Phone Number Business Years Acquainted

All information provided is subject to the North Dakota Open Records Law.
Jamestown Parks & Rec does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services and complies with the provisions of the North Dakota Human Rights Act.
AUTHORIZATION
I certifty that all facts contained in this application are true and complete to the best of my knowledge and understand and agree that any misstatement will be grounds for disqualification or dismissal from employment by Jamestown Parks and Recreation.

I authorize investigation of all statements contained herein and the references and employers listed to give you any and all information concerning my previous and any pertinent information they may have, personal or otherwise, to include a background check into felony convictions and child neglect or abuse and release Jamestown Parks and Recreation of any liability and any damage that may result from utilization of such information.

I understand by providing information on this application that there is no contractual or implied agreement between myself and Jamestown Parks and Recreation.


Signature: *




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