TOWN OF CEDAR BLUFF, 3120 Spring Street, Cedar Bluff, AL  35959

                               

Employment Application                                                      PHONE: 256-779-6121 FAX:  256-779-6148

Applicant Information

Last Name

 

First

 

M.I.

Date

 

Street Address

 

Apartment/Unit #

 

City

 

State

 

ZIP

 

Phone

 

E-mail Address

 

Date Available

 

Social Security No.

 

Desired Salary

 

Position Applied for

 

Are you a citizen of the United States?

YES 

NO 

If no, are you authorized to work in the U.S.?

YES 

NO 

Have you ever worked for this company?

YES  

NO  

If so, when?

 

Have you ever been convicted of a felony?

YES  

NO  

If yes, explain

 

 

Education

High School

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

College

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

Other

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

Position Desired   

 

Wage Desired

 

FULL TIME_________             PART TIME_________

                                                                            

DAYS AVAILABLE

 

MON­­­              TUES              WEDS              THURS             FRI              SAT              SUN

 

 

 

 

 

 

 

 

Previous Employment

Company

 

Phone

(           )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

Company

 

Phone

(         )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

Company

 

Phone

(         )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

SKILLS: Please list technical skills, clerical skills, trade skills, etc., relevant to this position.  Include relevant computer

systems and software packages of which you have a working knowledge, and note your level of proficiency

(basic, intermediate, expert)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

references

Please list three references other than relatives

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 
Full Name                                                                                               Relationship
Company                                                                                               Phone           (          )
Address  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                 APPLICATION FORM WAIVER

                                   

                                                                        Please read carefully!

 

 

            As indication that you have read and understood each sentence, please write your initials in the spaces

            provided below.

 

                In exchange for the consideration of my job application by the Town of Cedar Bluff, (hereinafter called

“the Town”), I agree that:

 

Neither the acceptance of this application, nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and  regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements and the like as they may exist from time to time , or other Town practices, shall serve to create an actual or implied contract of employment___ or to confer any right to remain an employee of the Town, or otherwise to change in any respect the employment–at-will relationship between it and the under signed___and that relationship cannot be altered except by a written instrument signed by the Town Council/Mayor___.

            Both the under signed and the Town may end the employment relationship at any time, without

            specified notice or policies and procedures and such changes may include reduction in benefits.___.

 

I authorize investigation of all information contained in this application,___  . I understand that the misrepresentation or omission of facts called for is caused for dismissal at any time without any previous notice___. I hereby give the Town permission to contact schools, all previous employers (unless otherwise indicated), references and others and hereby release the Town from any liability as a result of such contact___.

 

I understand that, in connection with the routine processing of your employment application, the Town may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living___.

Upon written request from me, the Town, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act___.

           

I further understand that my employment with the Town shall be probationary for a period of ninety (90) days and further that at any time during the probationary period or thereafter, my employment relationship with the Town is terminable at will for any reason by either party___.

 

 

 

 

                APPLICANT SIGNATURE___________________________________________________________DATE_________________________

                                                           

The Town of Cedar Bluff is an equal employment opportunity employer, we adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with the Town of Cedar Bluff depends solely on your qualifications.

 

Thank you for completing this application for and for you interest in our business.