City of Kirkwood : Employment Application

Employment Application

The City of Kirkwood welcomes you as an applicant for employment. Your application will be considered with others in competition for the position in which you are interested. It is our policy to provide equal employment opportunities to all applicants. Individuals are evaluated and selected solely on the basis of their qualifications regardless of race, age, sex, religion, national origin, disability or handicap.

Please furnish complete and accurate information so that we can properly evaluate your application. Be warned that providing false or misleading information or omitting important facts may be grounds for immediate dismissal. Also note that information you provide herein may be subject to later verification and/or testing. You may attach to this application any additional information that helps explain your qualifications.

Personal Information

Last Name: First Name: Middle Name: E-mail:	Previous Name: Social Security Number: Home Phone: Work Phone: May we call you at work?YesNo
Present Address Address: City: State: Zip:	Permanent Address Same as Present Address Address: City: State: Zip:

Work Preference

Position for which you are applying:
(Be specific to assure correct position consideration.)

Are you interested in: Full Time
Part Time
Temporary

General Information

Have you applied here before? YesNo
Have you been convicted of any crime during the past 10 years? YesNo
Do you have any relatives employed by the City of Kirkwood? YesNo

Education

School Name and Location	Did you graduate?	Degree, Diploma, Certifcate and Major/Minor
High School	YesNo
Vocational, Technical School	YesNo
College or University	YesNo YesNo
Other (Skilled traning, etc.)	YesNo
Please list academic honors, scholarships, fellowships, and memberships in professional and honorary societies.

Are you applying for a police officer or firefighter position: YesNo

Special Skills

Clerical Skills

What is your typing speed per minute?

Can you operate dictating equipment? YesNo
List any computer software that you are familiar with:

List other office equipment you can operate:

Trade Skills

Do you have experience in a skilled trade? If so, please describe the extent/nature of experience:

Have you completed an apprenticeship in a skilled craft? YesNo
List all machines and equipment you have operated:

List current licenses and/or certifications together with an identification of the granting authority:

Employment History

Please give accurate, complete full-time and part-time employment record. Start with present or most recent employer.

Employer 1: (Current or most recent employer)

Company Name:

Address:

Telephone:

State job title and list your duties/responsibilities beginning with the duty that consumed the greatest portion of your time.

Reason for Leaving:

Name of Supervisor: May we contact him/her? YesNo
Employment Status:Full TimePart Time
Dates of Employment:

From:

Open the calendar popup.

To:

Open the calendar popup.

(leave blank if current employer)

Salary:
HourlyMonthlyYearly

Employer 2:

Company Name:

Address:

Telephone:

State job title and list your duties/responsibilities beginning with the duty that consumed the greatest portion of your time.

Reason for Leaving:

Name of Supervisor: May we contact him/her? YesNo
Employment Status:Full TimePart Time
Dates of Employment:

From:

Open the calendar popup.

To:

Open the calendar popup.

(leave blank if current employer)

Salary:
HourlyMonthlyYearly

Employer 3:

Company Name:

Address:

Telephone:

State job title and list your duties/responsibilities beginning with the duty that consumed the greatest portion of your time.

Reason for Leaving:

Name of Supervisor: May we contact him/her? YesNo
Employment Status:Full TimePart Time
Dates of Employment:

From:

Open the calendar popup.

To:

Open the calendar popup.

(leave blank if current employer)

Salary:
HourlyMonthlyYearly

References

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

Name	Address	Phone

List professional, trade, business or civic activities and offices held. (Exclude those which indicate race, color, religion, sex or national origin):

By submitting this online application you are agreeing to the terms and conditions stated below:

I hereby certify that all statements are true and complete and authorize investigation of all information contained in this application. I understand that my present employer will not be contacted for employment verification until I have become one of the finalists for the position for which I am applying.
Organizations and persons named herein are authorized to give information regarding me and they are hereby released from all liability for issuing such information.
I understand that misrepresentation or omission of facts called for herein will be sufficient cause for cancellation of consideration for employment or dismissal if I have been employed.
I understand that any position that I am offered with the City of Kirkwood may be contingent upon my passing a physical examination and passing a substance abuse test.
I understand that the City of Kirkwood maintains a substance abuse policy and that I must comply with the policy as a condition of employment with the City.
I understand that I may also be subject to a psychological examination.

Kirkwood City Hall
139 S. Kirkwood Road
Kirkwood, Missouri 63122
314-822-5800
8am to 5pm

Kirkwood Community Center
111 S. Geyer Road - 63122
314-822-5855
Mon-Thurs: 8am to 7:30pm
Fri: 8am-5:30pm. Sat: 9am-noon

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