City of York, NE Employment Form - City of York, Nebraska

Position

Position Applying For

Date Available(Required)

Desired Salary(Required)

Applicant Information

Name

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Are you authorized to work in the United States?(Required)

Yes

Have you ever worked for the City of York?(Required)

Yes

If yes, when and what position?

Military Service

Have you served in the military?

Yes

Branch

Rank at Discharge

Type of Discharge

Type of Discharge If other than honorable, explain:

This position is subject to a veteran's preference. Are you eligible for and requesting a veteran's preference?

Yes

A veteran requesting preference must submit with his/her Application of Employment a copy of the veteran’s Department of Defense Form 214. A spouse of a veteran requesting preference must submit with his/her application for employment a copy of the veteran’s Department of Defense Form 214, a copy of the veteran’s disability verification from the United States Department of Veteran Affairs demonstrating a 100 percent permanent disability rating, and proof of marriage to the veteran.

Education

High School or Equivalent(Required)

Did you graduate?(Required)

Yes

Degree(Required)

College

Did you graduate?

Yes

Degree

Other

Did you graduate?

Yes

Degree

Previous Employment

Company(Required)

Phone(Required)

Address(Required)

Supervisor

Job Title(Required)

Starting Salary(Required)

Ending Salary(Required)

Responsibilities(Required)

Start Date(Required)

End Date(Required)

Reason for Leaving(Required)

May we contact your previous supervisor for a reference?(Required)

Yes

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Start Date

End Date

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Start Date

End Date

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

References

Name(Required)

Relationship(Required)

Company(Required)

Phone(Required)

Email(Required)

Name(Required)

Relationship(Required)

Company(Required)

Phone(Required)

Email(Required)

Name(Required)

Relationship(Required)

Company(Required)

Phone(Required)

Email(Required)

Additional Qualifications and Special Skills

Please list any additional qualifications or special skills below.

Referral Source

How did you hear about this opportunity?

Disclaimer & Signature

I acknowledge that if hired by the City of York, employment is on an at-will basis. This means the City of York is free to terminate my employment at any time, with or without cause or advance notice, in accordance with state law, and acceptance of employment is not a contract of employment for any specified time. Similarly, I am free to terminate my employment with the City of York at any time for any reason. This at-will provision may be modified or waived only in a written agreement signed by an authorized representative of the City of York and me. I agree to conform to the rules and regulations of the City of York, and I understand that the City of York has complete discretion to modify such rules and regulations at any time, except that it will not modify its policy of employment at-will.

I authorize the City of York or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation. Additionally, I authorize the City of York to complete a preliminary background investigation to determine if I qualify for the position I am applying.

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Electronic Signature (typing your full name constitutes a signature)(Required)

Today's Date

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