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APPLICATION FOR EMPLOYMENT (PLEASE PRINT) Position(s) Applied For Date of Application How Did You Learn About Us? Advertisement Friend Walk-In Employment Agency Relative Last Name First Name Middle Name Address Number Street City State Zip Code Telephone Number(s) Social Security Number If you are under 18 years of age, can you provide required proof of State Approved Driver’s Education Course? Yes No Have you ever filed an application with us before? Yes No If Yes, give date Have you ever been employed with us before? Yes No If Yes, give date Division Are you currently employed? Yes No Are you prevented from lawfully becoming employed in this Country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment. Yes No On what date would you be available for work? Are you available to work: Full Time Part Time Seasonal Temporary Are you related to any current Parks & Recreation District employees? Yes No If yes, employee’s name Have you ever pled “guilty” or “no contest” to, or been convicted of a crime? Yes No If yes, please provide date(s) and Answering “yes” to these questions does not constitute an automatic bar to employment. Factors such as date of offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account. Driver’s License number if driving is an essential job function State WE ARE AN EQUAL OPPORTUTNITY/ADA EMPLOYER We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. Those applicants requiring reasonable accommodation to the application and/or interview should notify the Director of the Evanston Parks and Recreation District. Evanston Parks & Recreation District 275 Saddle Ridge Road Evanston, Wyoming 82930 (307) 789-1770 [EMAIL REDACTED] ---PAGE BREAK--- EDUCATION High School Undergraduate College/University Graduate/ Professional School Name and Location Years Completed 9 10 11 12 1 2 3 4 1 2 3 4 Diploma/Degree Describe Course of Study Describe any specialized training, apprenticeship, skills and extra-curricular activities. Describe any honors you have received State any additional information you feel may be helpful to us in considering your application Indicate any foreign languages you can speak, read and/or write FLUENT GOOD FAIR SPEAK READ WRITE List professional, trade, business or civic activities and offices held. You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status: REFERENCES Give name, address and telephone number of three references who are not related to you. Have you ever had any job-related training in the United States military? Yes No If yes, please describe Are you physically or otherwise unable to perform the duties of the job for which you are applying? Yes No ---PAGE BREAK--- EMPLOYMENT EXPERIENCE Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, handicap or other protected status. Employer Dates Employed WORK PERFORMED From To Address Telephone Number(s) Hourly Rate/Salary Starting Final Job Title Supervisor Reason for Leaving Employer Dates Employed WORK PERFORMED From To Address Telephone Number(s) Hourly Rate/Salary Starting Final Job Title Supervisor Reason for Leaving Employer Dates Employed WORK PERFORMED From To Address Telephone Number(s) Hourly Rate/Salary Starting Final Job Title Supervisor Reason for Leaving Employer Dates Employed WORK PERFORMED From To Address Telephone Number(s) Hourly Rate/Salary Starting Final Job Title Supervisor Reason for Leaving If you need additional space, please continue on a separate sheet of paper. Special Skills and Qualifications: Summarize special job-related skills and qualifications acquired from employment or other experience. Identify software programs you are proficient in, list any equipment you have operated, and any other skills that may be useful to the position you are seeking. ---PAGE BREAK--- APPLICANT’S STATEMENT I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless an authorized executive of this organization specifically acknowledges such change in writing. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. Signature of Applicant Date FOR PERSONNEL DEPARTMENT USE ONLY Arrange Interview Yes No Date: Time: Remarks: Interviewer Date Employed Yes No Date of Employment: Job Title Hourly/Rate Salary Department By: Date: Name and Title NOTES Revised 03/07/06