ONLINE APPLICATION FOR EMPLOYMENT

ALL INFORMATION IS REQUIRED

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CONTACT INFORMATION

Full Name
Phone Number
Street Address
City State Zip
Email Address

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POSITION INFORMATION

Position you are applying for?

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AVAILABILITY

Are you legally authorized to be employed in this country?
Yes No

Have you ever been convicted of a felony?
Yes No

If yes, explain:

Do you have any restrictions which may prohibit you from performing the functions of the job for which you are applying?
Yes No

If yes, explain:

Can you work Weekdays?
Yes No

Can you work Weekends?
Yes No

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EDUCATION

What is the highest level of education you have obtained?
High School College or Trade School
Completed Education? Yes No
Still in School? Yes No

Name of school attended:

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EMPLOYMENT HISTORY

Have you been employed in the past? Yes No

List, in order, each employer for the past five years (most recent first).

Employer:
Address:
City, State:
Phone Number:
Reason for Leaving:
Stopped working (Month), (Year).
Employed for years, months.

Employer:
Address:
City, State:
Phone Number:
Reason for Leaving:
Stopped working (Month), (Year).
Employed for years, months.

Employer:
Address:
City, State:
Phone Number:
Reason for Leaving:
Stopped working (Month), (Year).
Employed for years, months.

Employer:
Address:
City, State:
Phone Number:
Reason for Leaving:
Stopped working (Month), (Year).
Employed for years, months.

May we contact your present or former employers? Yes No

If not, which one:

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LEGAL

I, the undersigned understand and agree that (please check each line):

I acknowledge that under standard procedure a routine inquiry may be made to provide information on my character, general reputation, personal characteristics, and mode of living. More information about the nature and scope of such an inquiry, if one is made, will be provided upon written request.

I understand that employers for whom I have worked in the past may be requested to furnish THE CITY OF MIDWAY information concerning my past employment or activities and I hereby release such employers from my liability in connection therewith.

I understand that any false statement, omission or misrepresentation made in connection with my past record or any other part of my application for employment with THE CITY OF MIDWAY will be justification, should I be employed, for my dismissal regardless of when such fact may be discovered.

Indemnification. By signing this application, Applicant hereby indemnifies and agrees to hold THE CITY OF MIDWAY harmless for any costs, lost profits, damages and/or expenses (including without limitation, attorneys fees) incurred by THE CITY OF MIDWAY at any time as a result of actions, disputes or controversies in which THE CITY OF MIDWAY becomes a party, which arise out of any non-compete, trade secret, and/or confidentiality agreements and/or duties, whether express or implied by employment law or otherwise, that Applicant has in relation to third parties, including current or previous employers. Applicant acknowledges and agrees that by considering Applicant’s application, or, if it occurs, by hiring Applicant that THE CITY OF MIDWAY has provided sufficient consideration to Applicant to support the grant of this indemnification.

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other City practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of THE CITY OF MIDWAY, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the Mayor of the CITY OF MIDWAY. Both the undersigned and THE CITY OF MIDWAY may end the employment relationship at any time, without specified notice or reason. If employed, I understand that THE CITY OF MIDWAY may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

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SIGNATURE

To Sign, type full name:
Date:

THE CITY OF MIDWAY is an Equal Opportunity Employer and does not discriminate based on age, sex, race, religion, color, creed, national origin, marital status, or sexual orientation.