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Job Application
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Steps
1.
Personal Data
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This section is incomplete
2.
Position Information
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3.
Education and Training
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This section is incomplete
4.
Employment History
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5.
References
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6.
Disclaimer & Signature
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Personal Data
Which position are you applying for?
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First Name
*
Last Name
*
Mailing Address
*
Primary Phone Number
*
Physical Address
Alternate Phone Number
City
*
State
*
Zip
*
How long at present address?
Email Address
*
Driver's License Information
Driver's License State
*
DL Class
*
DL Expiration Date
*
Can you verify your legal rights to work in the United States by providing a birth certificate, proof of U.S. Citizenship, or by some other means? (Proof of citizenship or immigration status will be required upon employment.)
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Yes
No
Do you have adequate means of transportation to get to work on time each day and when called in on short notice?
*
Yes
No
List any relatives currently working for the City of Bridgeport
Name
Department
Relationship
Have you been convicted, pled guilty, or placed on deferred adjudication for any criminal offense other than traffic violations?
*
Yes
No
If yes, give dates and details. (Such record is not an automatic ban of employment. The nature of the crime will be considered in relation to the position for which you are applying):
Were you previously employed by this organization?
*
Yes
No
If yes, list dates and department(s):
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Position Information
Date you can begin work:
*
Will you work overtime whenever scheduled or requested?
*
Yes
No
Can you work weekends whenever scheduled or requested?
*
Yes
No
Would you accept part-time work?
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Yes
No
Would you accept temporary work?
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Yes
No
Special skills you possess (Electrical, Mechanical, Clerical or Technical)
How did you hear about the position?
*
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Education and Training
Have you served in the military?
*
Yes
No
If yes, state the type of military discharge received. (A less than honorable discharge is not an automatic ban to employment. The circumstances of the discharge will be considered in relation to the position for which you are applying):
High School
Name and Location of School
Course of Study
Number of Years Completed
Did You Graduate?
Yes
No
G.E.D.
Trade or Business
Name and Location of School
Course of Study
Number of Years Completed
Did you Graduate?
Yes
No
College
Name and Location of School
Course of Study
Number of Years Completed
Did You Graduate?
Yes
No
Graduate School
Name and Location of School
Course of Study
Number of Years Completed
Did You Graduate
Yes
No
Describe any special qualifications, skills, licenses, certificates, or other relevant training:
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Employment History
In the space provided below give your employment history, beginning with your PRESENT or most recent employer. List all positions held, including military, part-time, summer and volunteer work. If additional space is required, please attach additional sheet using the same format.
Employer
Telephone Number
Address
Supervisor
Start Date
Separation Date
Starting Hourly Rate / Salary
Final Hourly Rate / Salary
Reason for Leaving:
*
Job Title
Duties Performed
Employer
Telephone Number
Address
Supervisor
Start Date
Separation Date
Starting Hourly Rate / Salary
Final Hourly Rate / Salary
Reason for Leaving:
Job Title
Duties Performed
Employer
Telephone Number
Address
Supervisor
Start Date
Separation Date
Starting Hourly Rate / Salary
Final Hourly Rate / Salary
Reason for Leaving:
*
Job Title
Duties Performed
Employer
Telephone Number
Address
Supervisor
Start Date
Separation Date
Starting Hourly Rate / Salary
Final Hourly Rate / Salary
Reason for Leaving:
Job Title
Duties Performed
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References
Please list three professional or personal 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 READ THE FOLLOWING INFORMATION CAREFULLY, THEN SIGN AND DATE BELOW.
FALSIFICATION OF INFORMATION: I understand that my eligibility will be based on the information contained on this application. I certify that all statements made on this application are true and correct. I understand that any false statement made by me on this application could cause me to be ineligible for employment or terminated from employment. Further, I understand that I am required to abide by all rules and regulations of the employer.
VERIFICATION OF INFORMATION: I authorize the City of Bridgeport and its agents to investigate and verify the facts claimed by me on this application. I authorize any former employer, educational institution, organization, law enforcement agency, financial institution, consumer reporting agency, or other persons having personal knowledge concerning my work record, school record, driving record, military record, reputation, criminal history, or copies of such documents to provide any information requested by the City of Bridgeport and/or its agents. I further authorize the individuals listed as personal references to release any personal information that may pertain to my work habits or work performance. Furthermore, I hereby release from liability and hold harmless all persons, organizations, agencies or institutions supplying this information to the City of Bridgeport and/or its representatives. I also hereby release from liability and hold harmless the City of Bridgeport, Texas, relative to any documentation released to it pursuant to this Authorization. A photocopy of this Authorization is as effective as the original. I understand that consideration of my employment in this position is contingent upon the result of a reference and background check, and a post-offer medical examination and drug screen.
EMPLOYEE HANDBOOK: I understand and agree that any employee handbook, which I may receive, will not constitute an employment contract, but will be merely a gratuitous statement of City's current policies.
EMPLOYMENT AT WILL: I understand that nothing in this Application, or in any prior or subsequent written or oral statement, creates a contract of employment or any rights in the nature of a contract. I agree and understand that if I am hired by the City, my employment will be at will, for an indefinite period of time and may be terminated at any time, with or without cause or notice, at the option of the City or myself. I understand that I have the right to end my employment at any time and that the City retains that same right.
DRUG – FREE WORK ENVIRONMENT: The City of Bridgeport is committed to providing a safe, efficient, drug-free work environment for all employees. In keeping with this commitment, finalists for all job openings may be required to provide body fluids (blood or urine) to determine the use of alcohol, illegal or controlled substances in the work place. I understand that if I am employed with City of Bridgeport the City may require that I submit to a drug or alcohol screen if I apply for promotion, if I am involved in an on-the-job accident, or if the City has a reasonable suspicion that I am under the influence of drugs or alcohol, and I hereby authorize the release of the results of any physical examinations or drug tests required herein to City of Bridgeport. I further understand that the City may inspect all lockers and any bags (including purses or briefcases) or parcels brought into or taken out of City buildings, and that refusal to submit to a urinalysis, blood test or search, when requested to do so, may result in the termination of my employment. AN EQUAL OPPORTUNITY EMPLOYER: The City of Bridgeport considers all applicants for employment without regard to race, color, religion, ethnic affiliation, gender, genetics, national origin, age, disability, or veteran status, marital status, or any other protected status or classification in accordance with state and federal laws. The City of Bridgeport also provides reasonable accommodations to qualified individuals with known disabilities, in accordance with the Americans with Disabilities Act.
Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature
*
Date
Date
IF UNDER 18, YOUR PARENT OR GUARDIAN WILL NEED TO SIGN BELOW
I understand that my child is applying for a job with the City of Bridgeport
Yes
No
Parent or Guardian Signature
Date
Date
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