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2. 

4. APPLICATION FOR EMPLOYMENT

   AN EQUAL OPPORTUNITY EMPLOYER

   Our policy is to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, color, age, religion, creed, national origin, sex, disability, veteran, or marital status, or any other legally protected status.  If you are a person with a disability and need an accommodation in the application process, please notify the Human Resources Director.

   NOTE:  The City will not employ a qualifying patient in a safety or security sensitive position.

6. First Name*
7. Middle Initial*
8. Last Name*
10. Other names used while employed, if any
11. Email Address
13. Address*
14. City*
15. State*
17. Zip*
18. Phone Number Home*
19. Phone Number Cell
21. Position Applying For (do not list Any)*
23. Are you 18 years old or older? (yes or no)*
24. If you are applying for Police you must be 21 years old to apply. Are you 21 years old or older? (yes or no)
26. If you are applying for Part-time Seasonal are you 16 years old or older? (yes or no)
28. Are you presently employed? (yes or no)*
29. May we contact your present employer? (yes or no)*
31. Have you previously been employed by the City of Paragould? (yes or no)
32. Date from
    Date from
33. Date to
    Date to
34. Position Held
36. **Please list friends or relatives employed by the City of Paragould.
38. First / Last Name
39. Position
40. Relationship
42. First / Last Name
43. Position
44. Relationship
46. If you are hired, can you produce evidence of U.S. citizenship or legal work status within three (3) days? ( yes or no)*
48. **References (Do Not List Relatives)
50. Name*
51. Phone Number*
52. Occupation
53. Years Acquainted*
55. Name*
56. Phone Number*
57. Occupation
58. Years Acquainted*
60. Name*
61. Phone Number*
62. Occupation
63. Years Acquainted*
65. EDUCATION
67. Type of School
68. School Name/ Location
69. Course of Study
70. Diploma / Degree
72. Type of School
73. School Name / Location
74. Course of Study
75. Diploma / Degree
77. Type of School
78. School Name / Location
79. Course of Study
80. Diploma / Degree
82. Describe any specialized training, apprenticeship, and skills.
84. Describe any job-related training received in the United States military.
86. Please indicate any additional experience and training you have had which in your opinion would qualify you for the position you seek.
88. PREVIOUS EMPLOYMENT

    List all employment (including military service for at least the past ten (10) years).

    Begin with your most recent and work back.

90. 1. Firm Name
91. Address
93. City
94. State
95. Zip Code
97. Phone Number
98. Job Title
99. Date from
    Date from
100. Date to
     Date to
102. Primary Responsibilities
103. Hourly Rate / Salary
105. Name of Direct Supervisor
106. Phone Number
108. Reason for Leaving
109. Were you fired?
111. Name of Co-worker
112. Phone Number
114. 2. Firm Name
115. Address
117. City
118. State
119. Zip Code
121. Phone Number
122. Job Title
123. Date from
     Date from
124. Date to
     Date to
126. Primary Responsibilities
127. Hourly Rate / Salary
129. Name of Direct Supervisor
130. Phone Number
132. Reason for Leaving
133. Were you fired?
135. Name of Co-worker
136. Phone Number
138. 3. Firm Name
139. Address
141. City
142. State
143. Zip Code
145. Phone Number
146. Job Title
147. Date from
     Date from
148. Date to
     Date to
150. Primary Responsibilities
151. Hourly Rate / Salary
153. Name of Direct Supervisor
154. Phone Number
156. Reason for Leaving
157. Were you fired?
159. Name of Co-worker
160. Phone Number
162. Resume / Certificate Upload - Please do not upload documents with SS#, Birthdates, or DL#.
164. PLEASE READ CAREFULLY AND INITIAL EACH PARAGRAPH BEFORE SIGNING
166. I have disclosed all information that is relevant and should be considered applicable to my candidacy for employment. *

     Initials

168. I understand where permissible under applicable state and local law, I may be subject to a pre-employment drug test after receiving a conditional offer of employment, and must receive a negative result for illegal drugs before being permitted to commence work with the City of Paragould.*

     Initials

170. I understand, where permissible under applicable state and local law, I may be subject to a pre-employment medical examination after receiving a conditional offer of employment, and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with the City of Paragould.*

     Initials

172. I hereby certify that the information given by me is true in all respects. I authorize the City of Paragould and its representatives to contact my prior employers and all others for the purpose of verification of the information I have supplied and release same from any liability resulting from the information released. I authorize employers, schools and other persons named on this application to provide any information or transcripts requested. *

     Initials

174. I understand employment with the City of Paragould is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.*

     Initials

176. I expressly understand and agree that, if employed, my employment, having no specific term, is based upon mutual consent and may be terminated at will, with or without cause, by either party (the City of Paragould or me) without prior notice to the other, unless otherwise prohibited by law.*

     Initials

178. I understand that no representation, whether oral or written, by any representative or agent of the City of Paragould, at any time, can constitute an implied or expressed contract of employment. I further understand no representative or agent of the City of Paragould has the authority to enter into an agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other terms or condition of employment other than in a document signed by the Director of Human Resources or an authorized representative.*

     Initials

180. I certify, under penalty of perjury, that all of the above information is true and complete, and I understand that any falsification or omission of information may result in denial of employment or, if hired, may result in termination regardless of the time lapse before discovery.
182. This application for employment shall be considered active for a period of time not to exceed 180 days. Any applicant wishing to be considered for employment beyond this time period should reapply.
184. NOTE; An offer of employment is conditioned upon complying with the City of Paragould’s requirements including, but not limited to signing a consent to conduct a background investigation
186. MY SIGNATURE IS EVIDENCE THAT I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.
188. Applicant's Signature*
189. Date*
Leave This Blank:


191. 1. Receive an email copy of this form.
192. Email address

     This field is not part of the form submission.

193. Submit

* indicates a required field