Job Application - Girard, Kansas

Personal Information

Date

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Position Applying For

Date Available

Desired Salary

General Questions

Are you a US Citizen?

Yes
No

If no, are you authorized to work in the US?

Yes
No

Have you ever worked for the City of Girard?

Yes
No

Have you ever been convicted of a felony?

Yes
No

If yes, please explain

Education

High School Name

a School Title

Did you graduate?

Yes
No

Additional Education, Certifications or Training

Professional References

Please list 3 professional references including Full Name, Relationship, Company, Address and Phone Number

Reference 1

Reference 2

Reference 3

Employment History

Please list your most recent first

Previous Employer

Employer Name

Job Title / Position

Address

Starting / Ending Dates

Responsibilities

Reason for Leaving

May we contact this Employer?

Yes
No

Background Check Authorization

I authorize the City of Girard to conduct a background check / driver's license check through the Kansas Department of Revenue, Divisions of Vehicles.

Driver's License #

Authorization

I authorize the City of Girard to conduct a background check / driver's license check

Certification

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature

Type your full name as your electronic signature

Date