City Of Seymour Employment Application Form General Information

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City of Seymour
Employment Application Form
If you need assistance completing this form, assistance will be provided.
Equal Opportunity Employer – Discrimination in employment because of race, religion, creed, color,
national origin, ancestry, age, sex, or liability for service in the Armed Forces of the United States is
prohibited by City policy. In addition, the City employment policy requires compliance with national and
state employment practices, laws, and regulations. The City of Seymour is an equal opportunity employer.
Name:
Date:
Last
First
Middle
Address:
City:
State:
Zip Code:
Day Phone:
Evening Phone:
Social Security Number:
General Information
Are you 18 years or older?
O Yes
O No
If no, state age:
What type of Drivers License do you hold? O None O Operators
O Commercial
O Other
Has the City of Seymour ever employed you?
O Yes O No
If yes, state department(s) and date(s):
Do you have relatives working for the City of Seymour, in the department for which you are applying?
Have you ever pled guilty to or been convicted of a felony?
O Yes O No
If yes, explain. (Note: This answer will be considered only as it relates to fitness to perform the job)
Are you seeking work:
O Full-time
O Part-time
O Temporary
Position (s) applying for:
If not applying for a specific position, indicate other preferred job (check one area below):
O Officials & Administrators
O Technician
O Clerical / Office
O Professional
O Skilled Craft
O Laborer
Education
School
Name & Location
Last year
Major
Did you
Completed
Graduate?
Grade
School
High
School
Technical
College
Other
Other education related information:
Military Data
Dates of Service:
From:
To:

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