Form Center

2. 

3. City of Kingsford

   The Progressive City

   
   

   APPLICATION FOR EMPLOYMENT

5. PERSONAL INFORMATION

7. First Name*
8. Last Name*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Phone Number*
17. Social security number will be requested upon conditional offer of employment
19. Email Address*
23. POSITION APPLYING FOR*
24. DATE YOU CAN START*
25. ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?*

    1. Yes
    2. No
27. ARE YOU EMPLOYED NOW?*
    -- Select One --YesNo
28. IF SO, MAY WE CONTACT YOUR EMPLOYER?*

    1. Yes
    2. Contact me first
    3. Not at this time
29. HAVE YOU PREVIOUSLY APPLIED WITH THIS ORGANIZATION?*

    1. Yes
    2. No
    3. Don't remember
31. HAVE YOU PREVIOSLY WORKED FOR THIS ORGANIZATION?*

    1. Yes
    2. No
32. IF SO, WHICH DEPARTMENT AND WHEN?*
33. NAME OF SUPERVISOR IF PREVIOUSLY EMPLOYED WITH THIS ORGANIZATION*
35. HOW DID YOU HEAR ABOUT US?*
    -- Select One --Present/past employeeCity WebsiteJob Search Website, Michigan Works, etc.Newspaper AdOther referral

39. EDUCATION

41. NAME OF SCHOOL*
42. LOCATION OF SCHOOL*
43. YEARS ATTENDED/DID YOU GRADUATE?*
44. SUBJECTS STUDIED*
46. NAME OF SCHOOL*
47. LOCATION OF SCHOOL*
48. YEARS ATTENDED/DID YOU GRADUATE?*
49. SUBJECTS STUDIED*
51. NAME OF SCHOOL*
52. LOCATION OF SCHOOL*
53. YEARS ATTENDED/DID YOU GRADUATE?*
54. SUBJECTS STUDIED*
56. HIGHEST LEVEL ATTAINED*
    -- Select One --Grammar SchoolHigh School Diploma or GEDSome CollegeLess than Associate's DegreeAssociate's DegreeBachelor DegreeMaster's Degree or above

60. GENERAL

62. SPECIAL TRAINING*
64. SPECIAL SKILLS*

68. PREVIOUS WORK HISTORY

70. PLEASE LIST ANY CERTIFICATIONS, ENDORSEMENTS OR LICENSES YOU HOLD
72. NAME OF EMPLOYER*
73. ADDRESS, CITY, STATE & ZIPCODE
75. START DATE (MM/YY)*
76. END DATE (MM/YY)*
77. JOB TITLE*
79. NAME OF SUPERVISOR & TITLE*
80. MAY WE CONTACT YOUR SUPERVISOR?*
    -- Select One --YesContact me firstNot at this time
81. SUPERVISOR'S PHONE NUMBER
83. BRIEF DESCRIPTION OF JOB DUTIES*
85. REASON FOR LEAVING*
89. NAME OF EMPLOYER*
90. ADDRESS, CITY, STATE & ZIPCODE
92. START DATE (MM/YY)*
93. END DATE (MM/YY)*
94. JOB TITLE*
96. NAME OF SUPERVISOR & TITLE*
97. MAY WE CONTACT YOUR SUPERVISOR?*
    -- Select One --YesContact me firstNot at this time
98. SUPERVISOR'S PHONE NUMBER
100. BRIEF DESCRIPTION OF JOB DUTIES*
102. REASON FOR LEAVING*
106. NAME OF EMPLOYER*
107. ADDRESS, CITY, STATE & ZIPCODE
109. START DATE (MM/YY)*
110. END DATE (MM/YY)*
111. JOB TITLE*
113. NAME OF SUPERVISOR & TITLE*
114. MAY WE CONTACT YOUR SUPERVISOR?*
     -- Select One --YesContact me firstNot at this time
115. SUPERVISOR'S PHONE NUMBER
117. BRIEF DESCRIPTION OF JOB DUTIES*
119. REASON FOR LEAVING*

123. REFERENCES

     PLEASE PROVIDE THE NAMES OF (3) PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.

125. 1)

127. NAME*
128. ADDRESS
130. PHONE NUMBER*
131. RELATIONSHIP TO YOU*

135. 2)

137. NAME*
138. ADDRESS
140. PHONE NUMBER*
141. RELATIONSHIP TO YOU*

145. 3)

147. NAME*
148. ADDRESS
150. PHONE NUMBER*
151. RELATIONSHIP TO YOU*

155. SERVICE RECORD

157. BRANCH OF SERVICE
158. DISCHARGE DATE (MM/YY)
160. RANK

162. SPECIAL QUESTIONS

164. HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST 5 YEARS?*
166. IF YES, PLEASE EXPLAIN. (WILL NOT NECESSARILY EXCLUDE YOU FROM CONSIDERATION)*
168. AUTHORIZATION

     THE CITY OF KINGSFORD IS AN EQUAL OPPORTUNITY EMPLOYER. THE CITY OF KINGSFORD DOES NOT DISCRIMINATE IN EMPLOYMENT ON ACCOUNT OF RACE, COLOR, RELIGION, NATIONAL ORIGIN, CITIZENSHIP STATUS, ANCESTRY, AGE, SEX (INCLUDING SEXUAL HARRASSMENT), SEXUAL ORIENTATION, MARITAL STATUS, PHYSICAL OR MENTAL DISABILITY, MILITARY STATUS OR UNFAVORABLE DISCHARGE FROM MILITARY SERVICE. 

     "I UNDERSTAND THAT NEITHER THE COMPLETION OF THIS APPLICATION NOR ANY OTHER PART OF MY CONSIDERATION FOR EMPLOYMENT ESTABLISHES ANY OBLIGATION FOR THE CITY OF KINGSFORD TO HIRE ME. IF I AM HIRED, I UNDERSTAND THAT EITHER THE CITY OF KINGSFORD OR I CAN TERMINATE MY EMPLOYMENT AT ANY TIME AND FOR AN RASON, WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE. I UNDERSTAND THAT NO REPRESENTATIVE OF THE CITY OF KINGSFORD HAS THE AUTHORITY TO MAKE ANY ASSURANCE TO THE CONTRARY."

     "I ATTEST WITH MY SIGNATURE BELOW THAT I HAVE GIVEN TO THE CITY OF KINGSFORD TRUE AND COMPLETE INFORMATION OF THIS APPLICATION. NO REQUESTED INFORMATION HAS BEEN CONCEALED. I AUTHORIZE THE CITY OF KINGSFORD TO CONTACT REFERENCES PROVIDED FOR EMPLOYMENT REFERENCE CHECKS. IF ANY INFORMATION I HAVE PROVIDED IS UNTRUE, OR IF I HAVE CONCEALED MATERIAL INFORMATION, I UNDERSTAND THAT THIS WILL CONSITUTE CAUSE FOR THE DENIAL OF EMPLOYMENT OR IMMEDIATE DISMISSAL."

170. Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
172. Electronic Signature*
174. Printed Name*
175. Date*

177. THIS APPLICATION IS VALID ONLY FOR 90 DAYS FROM THE DATE SIGNED ABOVE. 

179. City of Kingsford

     305 S. Carpenter Avenue

     PH: (906)774-3526

     Fax: (906)774-7093

     City of Kingsford's Website

     
     

     This institution is an Equal Opportunity Provider and Employer

Leave This Blank:


181. 1. Receive an email copy of this form.
182. Email address

     This field is not part of the form submission.

183. Submit

* indicates a required field