Job Application Form Job Application FormStep 1 of 616%Contact InformationFirst Name*Last Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Telephone*Email* Position DetailsPosition Applied ForStreets LaborerStreets Equipment Operator 3Maintenance Repairperson 1Maintenance Repairperson 2Desired WageWhen can you start?*How did you hear of this opening?Are you 18 years of age or older?* Yes NoAre you a U.S. Citizen or otherwise authorized to work in the U.S. on an unrestricted basis?* Yes NoAre you looking for full time employment?* Yes NoIf not, what hours are you available?EducationGrammar School Attended: Name & LocationHigh School Attended: Name & LocationHigh School Years Completed 1 2 3 4Did you graduate high school? Yes NoHigh School Subjects StudiedCollege Attended: Name & LocationCollege Years Completed 1 2 3 4Did you graduate college? Yes NoCollege Subjects Studied & DegreesTrade, Business, or Correspondence School: Name & LocationYears Completed 1 2 3 4Did you graduate? Yes NoSubjects Studied & DegreesReferencesList three persons not related to you that you have known at least one yearReference 1 NameReference 1 AddressReference 1 PositionReference 1 Years AcquaintedReference 2 NameReference 2 AddressReference 2 PositionReference 2 Years AquaintedReference 3 NameReference 3 AddressReference 3 PositionReference 3 Years AcquaintedEmployment HistoryStart with most recent employer.Company 1 NameAddressTelephone NumberDate StartedDate EndedStarting WageEnding WageStarting PositionEnding PositionName of SupervisorMay we contact? Yes NoResponsibilitiesReason for leavingCompany 2 NameAddressTelephone NumberDate StartedDate EndedStarting WageEnding WageStarting PositionEnding PositionName of SupervisorMay we contact? Yes NoResponsibilitiesReason for leavingAdditional InformationIn addition to your work history, are there any other skills, qualifications or experience we should consider?If you are to be hired by the City of Gretna, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.AUTHORIZATIONI certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. I understand that any employment is conditioned on a background check. I authorize the City of Gretna to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the City of Gretna, without giving me prior notice of such disclosure. In addition, I release the City of Gretna, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure. I understand and agree that nothing in this application, or conveyed during my interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment is “at will” and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the City of Gretna. No promise regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the City of Gretna unless made in writing. If I am employed, I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the City of Gretna and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to the City of Gretna the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examination and drug tests, and if I am hired a condition of my employment will be that I abide by the City of Gretna’s Drug and Alcohol Policy. I understand that filling out this form does not indicate there is a position open and does not obligate the City of Gretna to hire, if hired, I agree to abide by all City of Gretna work rules, policies and procedures. The City of Gretna retains the right to revise its policies or procedures, in whole or in part at any time.Enter your full name as your electronic signature