Action Center / Employment Application / The City of Frankfort, Indiana

Position

Position you are applying for

Contact Information

Full Name

Address

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.

Phone

Phone Area Code-Phone Prefix-Phone Line Number ext Phone Extension

Email

Best time to contact you at home is:

Education

High School Name

High School Location

Did you graduate?

Yes

No

Did you attend college?

Yes

No

Have you received additional education?

Yes

No

What is your desired salary range?

Licenses, Certifications, and Registrations

List any Licenses, Certifications, and Registrations received

Record

Are you currently under investigation by any law enforcement agency or have you been convicted of any crime as an adult not expunged from your record?

Yes

No

If you answered yes to the above question, please provide an explanation

Status

Availability

Date First Available

MonthDay Year,

Can you travel if a job requires it?

Yes

No

Employment History

Are you currently employed?

Yes

No

Current Employer

Current Employer Address

Current Employer Phone

Current Employer Phone Area Code-Current Employer Phone Prefix-Current Employer Phone Line Number ext Current Employer Phone Extension

Supervisor Name

Job Title

From Date

MonthDay Year,

Describe job duties

Current Rate of Pay

Reason for leaving

May we contact your current employer as a work reference?

Yes

No

Have you been previously employed?

Yes

No

Previous Employer

Previous Employer Address

Previous Employer Phone

Previous Employer Phone Area Code-Previous Employer Phone Prefix-Previous Employer Phone Line Number ext Previous Employer Phone Extension

Supervisor Name

Job Title

From Date

MonthDay Year,

To Date

MonthDay Year,

Describe job duties

Previous rate of pay

Reason for leaving

May we contact your previous employer as a work reference?

Yes

No

Would you like to include an additional previous employer?

References

Please include the Name and Telephone Number of two (2) references not related to you

Please list any special job-related skills, certifications, and qualifications acquired from education, employment, volunteer work, or military service, which you feel, may be helpful in considering your application.

Applicant's Statement

Signature of Applicant

Date Signed

MonthDay Year,