Fillable Application For Employment - City Of Fairfield (Page 2 of 4) in pdf

Employment History

Provide the following information of your past three (3) employers, assignments or volunteer activities, starting with the most recent.

FROM

EMPLOYER

TELEPHONE #

STARTING/FINAL JOB TITLE

ADDRESS

IMMEDIATE SUPERVISOR /TITLE

SUMMARIZE THE NATURE OF WORK PERFORMED

REASON FOR LEAVING

HOURLY RATE/SALARY

START $

PER

FINAL $

PER

FROM

EMPLOYER

TELEPHONE #

STARTING/FINAL JOB TITLE

ADDRESS

IMMEDIATE SUPERVISOR /TITLE

SUMMARIZE THE NATURE OF WORK PERFORMED

REASON FOR LEAVING

HOURLY RATE/SALARY

START $

PER

FINAL $

PER

FROM

EMPLOYER

TELEPHONE #

STARTING/FINAL JOB TITLE

ADDRESS

IMMEDIATE SUPERVISOR /TITLE

SUMMARIZE THE NATURE OF WORK PERFORMED

REASON FOR LEA VING

HOURLY RATE/SALARY

START $

PER

FINAL $

PER

May we contact the employers listed above? [ ] Yes [ ] No

If not, indicate which you do not wish us to contact.

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the City of Fairfield is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further

consideration of this application, or (ii) immediately discharge me from the employers service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and

professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in

this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for

seeking, gathering and using information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any

applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my

employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or

contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any

assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by

the City of Fairfield, City Manager.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT

require me to complete an I-9 Form in this regard.

STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Application Statement.

Signature of Applicant _________________________________________________________ Date _ _____________________