Public Works Crew Employment Application

Applicants are considered for all positions without regard to race, color, sex, sexual orientation, religion, creed, national origin, ancestry, age, marital or veteran status, disability, handicap or arrest or conviction record.

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Position Applied For *

Personal Data

First Name *

Middle Initial *

Last Name *

Address *

City *

State *

Zip Code *

Telephone *

Email Address *

Employment Eligibility

Are you employed now? *

May we contact your present employer? *

On what date would you be available for work? *

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Are you eligible to work in the United States? *

Yes

(If offered employment, you will be required to provide documentation to verify eligibility.)

Have you been convicted of a crime (do not include minor traffic violations or ordinance violations)? *

Yes

(You must report all convictions, past and present. A conviction will not automatically disqualify you from employment but any dishonesty relevant to this response will remove your application from further consideration or result in termination of your employment.)

If yes, please explain:

Activities

List professional trade, business or community activities and offices held.

References

References *

Give name, address and telephone number of three references who are not related to you and are not previous employers.

Education and Formal Training

Do you have a high school diploma of GED certificate? *

Colleges, military, trades, business or other schools attended: *

Provide Name & Location, Course of Study, Dates, and Degree/Diploma

Licenses or Certificates you have that indicate specialized skills or training:

Title of License or Certificate, Issuing Agency, Skill Area

Are there any special skills you have that you would like us to be aware of?

Work Experience

Most Recent Employer *

Provide the employer name, address, supervisor's name and telephone number.

Most Recent Job Title *

Most Recent Job Duties *

Most Recent Dates of Employment *

Provide beginning and ending employment dates.

Most Recent Reason for Leaving *

2nd Most Recent Employer

Provide the employer name, address, supervisor's name and telephone number.

2nd Most Recent Job Title

2nd Most Recent Job Duties

2nd Most Recent Dates of Employment

Provide beginning and ending employment dates.

2nd Most Recent Reason for Leaving

3rd Most Recent Employer

Provide the employer name, address, supervisor's name and telephone number.

3rd Most Recent Job Title

3rd Most Recent Job Duties

3rd Most Recent Dates of Employment

Provide beginning and ending employment dates.

3rd Most Recent Reason for Leaving

Supplemental Questions

How would you work with the public? *

How would you manage employees? *

How would you handle record keeping? *

Supporting Information

Cover Letter

Upload your cover letter.
Files must be less than 5 MB.
Allowed file types: txt pdf doc docx.

Resume

Upload your resume.
Files must be less than 2 MB.
Allowed file types: txt pdf doc docx.

Certification

By signing below, I certify that all statements made on this application are true and correct. I understand that all information is subject to verification. I also understand that any falsification will disqualify me from employment or, if already employed, will result in dismissal. My signature authorizes the City of Dodgeville to secure my driving record (if the position requires driving), transcripts from educational institutions to verify credits/degrees, employment-related information from former employers or references, and any information needed to complete a criminal background check. I understand that I may be asked to undergo a physical examination, including substance abuse screening, prior to appointment to a position with the City of Dodgeville; I also understand that refusal to participate will result in the withdrawal of any offer of employment.

Signature *

Type Your Full Name

Date *

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Public Works Crew Employment Application

Applicants are considered for all positions without regard to race, color, sex, sexual orientation, religion, creed, national origin, ancestry, age, marital or veteran status, disability, handicap or arrest or conviction record.

Contact Information