Name
*
First Name
Last Name
Phone Number
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Checkbox
*
Have you been convicted of any felonies other than minor traffic violations in the past seven years? (A criminal conviction will not automatically bar employment, but will be considered only as it reasonably relates to your fitness to perform in the position for which you are applying).
If yes, explain:
Please check the box of last level of education completed
*
Name/Address of High School
*
Graduated?
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Major Courses Studied and GPA
*
Name and Address of College(s)/Universities
*
Major Courses Studied and GPA
*
List any scholarships, academic honors, awards or special achievements:
*
List any skills that you have that are appropriate for the position you are applying for:
*
If required will you work rotating shifts?
*
If required will you work Saturdays?
*
If required will you work overtime?
Position applying for (be specific):
*
Salary Requirements:
*
Per:
If currently employed, may we contact your employer?
Salary Begin/End:
*
Dates of Employment From/To (Mo/Yr to Mo/Yr):
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Name and Title of your Supervisor
*
Title of your Position
*
Salary Begin/End:
*
List jobs held, duties performed, skills used and promotions while employed at this company:
*
Reason for leaving:
*
Salary Begin/End:
*
Dates of Employment From/To (Mo/Yr to Mo/Yr):
*
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Name and Title of your Supervisor:
*
Title of your Position:
*
Salary Begin/End:
*
List jobs held, duties performed, skills used and promotions while employed at this company:
*
Reason for Leaving:
*
Salary Begin/End:
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Name and Title of your Supervisor
*
Title of your Position
*
Salary Begin/End:
Reason for Leaving
*
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Name and Title of your Supervisor:
*
Title of your Position:
*
Salary Begin/End:
*
List jobs held, duties performed, skills used and promotions while employed at this company:
*
Reason for Leaving:
*
Business Reference #1 Name
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Relationship:
*
2nd Business Reference Name:
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Relationship:
*
3rd Business Relationship Name:
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Relationship:
*
Applicant Affidavit: 1.) I certify that all statements given by me on this application, on my resume or other supplementary material are true and correct without omission. I understand that falsification or omission of any information required by this form is sufficient grounds for immediate disqualification of candidacy or termination of my employment by the City of Boulder. I authorize the references listed ablove to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. 2.) I understand that should employment be extended to me, I may be subject to the satisfactory results of any job related pre-employment examination required by the City of Boulder and my electronic signature indicates my consent to such testing. DO NOT SIGN ELECTRONICALLY UNTIL YOU HAVE READ THE PREVIOUS STATEMENTS. I certify that I have read and fully understand and accept all terms of the above statements. Name and date below:
*
City of Boulder Applicant Information Release. I hereby authorize the City of Boulder to conduct a criminal background check on myself. APPLICANT'S FULL NAME:
*
If I have gone by any other names than previously listed, I shall list them all here:
*
Applicant's Birthdate:
*
Applicant's Social Security Number:
*
Applicant's Driver's License Number:
*
Electronic Signature (full name):
