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APPLICATION FOR EMPLOYMENT City of Evanston 1200 Main Street Evanston, WY 82930 (307) 783-6300 Fax (307) 783-6390 www.evanstonwy.org [EMAIL REDACTED] We consider applicants for all position without regard to race, color, religion, creed, gender, national origin, age, disability, martial or veteran status, sexual orientation, or any other legally protected status. Those applicants requiring reasonable accommodation to the application and/or interview should notify a representative of the Human Resources Department. Position(s) applied Last First Middle Street City Employees must reside in the Uinta County School District #1 boundaries within 6 months from employment Mailing City, State, ZipCode If you are under 18 year of age and it is required, can you furnish a work permit? Yes No Are you related to any current City employees? Yes No If yes, employee’s Are you legally eligible for employment in this country? Yes No If you are currently employed, may we contact your present employer? Yes No Date you are available for 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 AN EQUAL OPPORTUNITIY/ADA EMPLOYER ---PAGE BREAK--- Years Degree/Diploma Name & Address of School Completed Received High School College/University Graduate/Professional Other (Specify) From To Employer Telephone Job Title Address Contact Person Summarize the nature of the work performed May we Contact for a Reference? Reason for leaving? Hourly Rate/Salary Start From To Employer Telephone Job Title Address Contact Person Summarize the nature of the work performed May we Contact for a Reference? Reason for leaving? Hourly Rate/Salary Start Education Experience ---PAGE BREAK--- From To Employer Telephone Job Title Address Contact Person Summarize the nature of the work performed May we Contact for a Reference? Reason for leaving? Hourly Rate/Salary Start From To Employer Telephone Job Title Address Contact Person Summarize the nature of the work performed May we Contact for a Reference? Reason for leaving? Hourly Rate/Salary Start Typing speed per minutes Do you have a CDL license? Yes No Identify software programs you are List heavy equipment you have operated: Proficient in: Other Skills: Other equipment: Other Skills and Abilities ---PAGE BREAK--- Indicate any foreign languages you can speak, read and/or List any other additional information you would like us to Name Contact Telephone Number(s) Relationship Applicant’s Statement I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the 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 to time not to exceed three months. Any applicant wishing to be considered beyond this time period should inquire as to whether or not applications are being accepted at that time. In the event of my employment, I understand that false or misleading information given in my applications or interview may result in discharge. I also understand that I am required to abide by all rules and regulations of the employer. Signature Date References ---PAGE BREAK---