Application For Employment - City Of Fairfield
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4City of Fairfield
5350 Pleasant Avenue
Fairfield, OH 45014
APPLICATION FOR EMPLOYMENT
Position applied for ______________________________________________________ Date of application ____________________
Name __________________________________________________________ Social Security # _____________________________
LAST
FIRST
MIDDLE
Address ___________________________________________________________________________________________________
STREET
CITY
STATE
ZIP CODE
Telephone # _(____)___________________ Mobile/Pager #_________________________ E-mail Address ___________________
Are you under 18?
[ ] Yes [ ] No
If you are under 18, and it is required, can you furnish a work permit?
[ ] Yes [ ] No
If no, please explain __________________________________________________________________________________________.
Were you ever employed here before? _______________ If yes, when?/position? ________________________________________.
Are you legally eligible for employment in this country? [ ] Yes [ ] No
Date available for work ________________________.
Type of employment desired?
[ ] Full-time
[ ] Part-time
[ ] Temporary/Seasonal.
Specify days and hours if part-time or temp/seasonal ________________________________________________________________.
Have you ever pled “guilty” or “no contest” to, or been convicted of a crime?
[ ] Yes [ ] No
If yes, please provide date(s) and details __________________________________________________________________________.
Driver’s License Number _____________________________________________State____________________________________ .
Skills & Qualifications
Summarize any special training, skills, licenses and/or certifications that may qualify you as being able to perform job-related
functions in the position for which you are applying.
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Educational Background
School
Name & Address
Number
of
years
Course of Study
Completed – Graduated
High
College
Other
(specify)
Personal References
Name & Occupation
Address
Phone Number
The City of Fairfield is an Equal Opportunity Employer. We consider applicants for all positions without regard to race, color,
religion, gender, national origin, age, disability, veteran status or any other legally protected status.
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Parent category: Business