Employment Application Form
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4PD60 (ML REV. 10/14)
CITY OF SAINT LOUIS
EMPLOYMENT
APPLICATION
DEPARTMENT OF PERSONNEL
THE CITY OF ST. LOUIS DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, ANCESTRY, RELIGION, AGE,
DISABILITY, SEX OR SEXUAL ORIENTATION, GENDER IDENTITY OR EXPRESSION, GENETIC INFORMATION, MARITAL STATUS OR RETALIATION
THE CITY OF SAINT LOUIS IS AN EQUAL OPPORTUNITY EMPLOYER
GENERAL INSTRUCTIONS:
A. Print clearly or typewrite information.
B. A separate application must be filed for each position in which you are interested.
C. Notify the Department of Personnel of any change in your mailing address.
D. Give complete answers to all questions. You must be able to substantiate any statement made on this form.
E. Return completed application to the City of St. Louis, Department of Personnel, 1114 Market Street, Room 700, St. Louis, MO 63101.
F. You may also file applications electronically. Visit the City web site at
1.
EXACT TITLE of Position for which you are applying.
(See examination announcement)
2.
LAST NAME
FIRST
MIDDLE
SOCIAL SECURITY NUMBER
3.
ADDRESS NUMBER
STREET
CITY
STATE
ZIP CODE
E-MAIL
ALTERNATE E-MAIL
4.
DATE OF BIRTH
5. TELEPHONE NUMBER
SECONDARY TELEPHONE NUMBER
/
/
(
)
(
)
6.
Have you ever been employed by the City of St. Louis in either a Civil Service position or a federally funded program?
Yes
No
If yes, please be sure to list the employment under EMPLOYMENT HISTORY (page 2).
7.
Are you a City of St. Louis resident or are you willing to move into the City within 120 days of completion of the initial working test
period?
Yes
No
Applicants for positions which require residency in the City of St. Louis will not be examined unless they are willing to move into the
City within the allotted time. See examination announcement for additional information regarding the residency requirement.
8.
Do you have any physical or mental impairment which will require an accommodation in the examining process?
Yes
No
If yes, explain under “REMARKS” (page 4).
9.
Are you a citizen of the United States?
Yes
No
If no, do you have permanent resident status?
Yes
No
Proof of permanent resident status will be required.
10.
Have you ever served in the armed forces?
Yes
No
If yes, complete the following:
Branch of service (check):
Army
Coast Guard
Marine Corps
Navy
Air Force
Entered __________________
Discharged __________________
Type of discharge __________________
Dates of service:
11.
If you are applying for a position which requires a professional license, certificate, or registration, including driver’s license,
complete the following:
What kind of license or certificate do you have? ______________________________
Number ____________________________
Where Issued ______________________ Class of license _____________________
Expiration date ______________________
DO NOT WRITE BELOW THIS LINE
FOR
AC./INC.
EXAM No.
ACC.
REJ.
REMARKS
OFFICE
USE
ONLY
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