Welcome to the Official Website for the City of Kendallville, Indiana

*Last Name:

*First Name:

*Home Address:

*City:

*State:

*ZIP Code:

*Phone number:

*Email address:

*Are you over 21 years of age?

Yes

EMPLOYMENT HISTORY AND WORK EXPERIENCE

Current Employer:

May we contact your current employer?

Yes

Current employer's address:

Current employer's phone number:

Date employed:

Current Job title:

Current Supervisor's name:

Current job beginning salary:

Current job ending salary:

Describe your current duties:

Why do you want to leave?

Previous Employer:

Previous employer's address:

Previous employer's phone number:

Dates employed at previous job:

Previous job title:

Previous supervisor's name:

Previous job beginning salary:

Previous job ending salary:

Describe your duties at previous job:

Why did you leave your previous job?

EDUCATION AND TRAINING

*High School Attended:

*Did you graduate high school?

Yes

High school equivalent (GED)?

Yes

Activities, awards, sports, etc. in high school:

College or Trade School Attended:

Dates of attendance at college or trade school:

Did you graduate college or trade school?

Yes

Degree from college or trade school:

Activities, awards, sports, etc. at college or trade school:

Graduate School Attended:

Dates of attendance at graduate school:

Did you graduate from graduate school?

Yes

Degree from graduate school:

Describe any relevant seminars or special training you have received:

PERSONAL INFORMATION

*Do you have any other commitments which might interfere with you employment with us?

Yes

If you have other commitments, please explain:

*Have you ever been convicted of a felony?

Yes

If convicted of a felony, please explain:

PLEASE LIST FOUR REFERENCES WHO ARE NOT RELATED TO YOU

Reference 1 Name:

Reference 1 Address:

Reference 1 Phone:

Reference 2 Name:

Reference 2 Address:

Reference 2 Phone:

Reference 3 Name:

Reference 3 Address:

Reference 3 Phone:

Reference 4 Name:

Reference 4 Address:

Reference 4 Phone:

Are you interested in:

Full-time permanent work

Part-time work

Temporary work

PLEASE READ EACH OF THE FOLLOWING PARAGRAPHS CAREFULLY. INDICATE YOUR UNDERSTANDING OF, AND CONSENT TO, THE CONTENTS AND CONDITIONS OF EACH PARAGRAPH BY PLACING YOUR INITIALS AT THE BESIDE EACH PARAGRAPH. IF YOU HAVE ANY QUESTIONS, CONTACT THE EMPLOYER PRIOR TO INITIALING THE PARAGRAPH.

*I understand and accept that, if I am hired, I may be hired conditional upon passing any medical and/or psychological examinations that the Employer deems to be necessary to determine my ability to perform the essential functions of the position. I understand that this shall include drug, alcohol or substance abuse testing.

*I understand and accept that the Employer requires a high degree of integrity and confidentiality of its employees. I also understand and accept that the various law enforcement and informational agencies that exchange information and data with the Employer require that the Employer's employees do not have a past record of unlawful activities. Therefore, I understand and accept that it will be necessary for the Employer to investigate my background for any criminal or unlawful activity.

*I understand that it may be necessary for me to approve and sign any waivers necessary in order for the Employer to obtain information from my current and former employers and educational transcripts from schools, colleges or universities I attend.

*I understand that the Employer provides a seven (7) day per week and twenty-four (24) hour per day service, and therefore, if employed, I may be required to work evening shifts or night shifts, including weekends.

*I understand and accept that if any information required in this application is found to be falsified or intentionally excluded, my application may be disqualified from further consideration. I further understand and accept that, if I am employed by the Employer, I may be subject to disciplinary action, including termination, if any information required by this application has been falsified or intentionally excluded.

BY PICKING ON THE SUBMIT BUTTON, I SOLEMNLY SWEAR THAT ALL OF THE INFORMATION FURNISHED IN THIS EMPLOYMENT APPLICATION IS TRUE, ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT ANY MISREPRESENTATIONS OR FALSIFICATION OF THE INFORMATION PROVIDED MAY LEAD TO WITHDRAWAL OF AN EMPLOYMENT OFFER OR TERMINATION FOLLOWING EMPLOYMENT. I AUTHORIZE INVESTIGATION OF MY BACKGROUND FOR ANY CRIMINAL OR UNLAWFUL ACTIVITY.

BY PICKING ON THE SUBMIT BUTTON, I HEREBY AGREE THAT I SHALL EXECUTE THE EMPLOYER'S CONDITIONAL AND POST-EMPLOYMENT MEDICAL EXAMINATION AND DRUG TESTING CONSENT FORMS. I RECOGNIZE THAT MY FUTURE EMPLOYEMENT WITH THE EMPLOYER WILL BE JEOPARDIZED IF I ENGAGE IN SUBSTANCE ABUSE, ILLIGAL DRUG USE OR ALCOHOL ABUSE.

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