APPLICATION FOR EMPLOYMENT

City of Hannibal
320 Broadway
Hannibal , Mo. 63401
Phone 573-221-0111
Fax 573-221-8191

Position applied for_____
Date of application

Name: ______________________________ Home Phone _________________

Please Print

Address: ______________________________ Work Phone __________________

Street

______________________________ e-mail _______________________

City State Zip

Are you willing to work evenings or week-ends,
if required?___________

If hired, first date you would be available to work?___________________

Have you ever been convicted of a felony or received a suspended imposition of sentence for a felony?_________

If so, explain circumstances: _____________________________________________________

______________________________________________________________________________

Can you operate an automobile? _____ Driver’s License # _______________ State ___

Do you have a CDL License?________

Do you have any recent arrests, suspensions or revocations in regards to driving?________

EDUCATION
NAME & LOCATION OF SCHOOL MAJOR/DEGREE

_____________________________________________________________________________

High School

_____________________________________________________________________________

College/University

_____________________________________________________________________________

College/University

_____________________________________________________________________________

Other Training

_____________________________________________________________________________

Other Training

If education or training was received under a different last name, please give name that appears on your school
or training records._________________________________

Please list your employment history, beginning with your present or most recent employer.

Employer Name _______________________________________________________________________________

Address ______________________________________________________________________________________

Date Started __________ Date left __________ Reason for leaving __________________________________

Describe Duties _______________________________________________________________________________

_____________________________________________________________________________________________

May we contact this employer for a reference?      _________Yes            __________ No

                                                                                                                  Phone_______________________________

Employer Name _______________________________________________________________________________

Address ______________________________________________________________________________________

Date Started __________ Date left __________ Reason for leaving _________________________________

Describe Duties _______________________________________________________________________________

_____________________________________________________________________________________________

May we contact this employer for a reference? _________Yes __________ No

Employer Name _______________________________________________________________________________

Address ______________________________________________________________________________________

Date Started __________ Date left __________ Reason for leaving____________________________

Describe Duties _______________________________________________________________________________

_____________________________________________________________________________________________

May we contact this employer for a reference? _________Yes __________ No

Phone_______________________________

Employer Name _______________________________________________________________________________

Address ______________________________________________________________________________________

Date Started __________ Date left __________ Reason for leaving______________________________

Describe Duties _______________________________________________________________________________

_____________________________________________________________________________________________

May we contact this employer for a reference? _________Yes __________ No

Phone_______________________________

Please list job knowledge or abilities that will be useful for the position applied for:

____________________________________________________________________________

Please list Professional or Character References (no relatives):

____________________________ ____________________________

Name Name

__________________________________________ __________________________________________

Address Address

__________________________________________ __________________________________________

City State Zip City State Zip

Phone_______________________________________ Phone_______________________________________

____________________________ ____________________________

Name Name

__________________________________________ __________________________________________

Address Address

__________________________________________ __________________________________________

City State Zip City State Zip

Phone_______________________________________ Phone_______________________________________

Additional comments:

____________________________________________________________________________

Applicants are encouraged to submit a resume, work samples, and academic records, if available.

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that by signing this application, I will allow a check on background and references as per indicated above. I also understand that if I am employed, any false statements on this application may result in dismissal. I authorize the City to make an investigation of any of the facts set forth in this application.

________________________________________________________ ____________

Applicant’s signature Date

Position applied for_____________________ Date of application________________

Are you willing to work evenings or week-ends, if required?___________

EDUCATION NAME & LOCATION OF SCHOOL MAJOR/DEGREE

Position applied for_____
Date of application

Are you willing to work evenings or week-ends,
if required?___________

EDUCATION
NAME & LOCATION OF SCHOOL MAJOR/DEGREE