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City of Whitefish Application for Employment Page 1 of 4 Use tab key to move through fields Notice To Applicants We welcome you as an applicant for employment. It is the policy of the City of Whitefish to consider applicants for all positions without regard to race, color, religion, creed, sex, national origin, age, marital status, the presence of a non-job related medical condition or physical disability or any other legally protected status unless related to a bona fide occupational requirement. A separate application, resume and other supporting documentation must be submitted for each job vacancy as required by the job position. LATE, INCOMPLETE and/or UNSIGNED* application material, including those which do not follow the instructions, will NOT be considered. Position Applied for: Department: Name: LAST FIRST MIDDLE INITIAL Present Mailing Address: City: State: Zip: Business Phone: ( ) Home Phone: ( ) Have you ever been convicted of a felony? Yes If yes, describe Do you claim veteran's preference? Yes (see note below*) No *If yes, you must provide a copy of legal documentation (DD-214) with this application. Have you worked for the City of Whitefish before? Yes No If yes, please give dates and department: Position: Department: From To Reason for leaving: Do you have a relative working for the City of Whitefish? Yes No If yes, what is their name? What relation? What Department do they work in? EDUCATION: Check highest grade completed 7 8 9 10 11 12 If you did not complete high school, do you have a high school equivalency diploma? Yes No High School: City State College/University: Degree/Cert Earned: City State Course of Study: Vocational/Business/Other: Degree/Cert Earned: City State Course of Study: Work Related References: Name: Work Relation: Company Name: Phone Name: Work Relation: Company Name: Phone Name: Work Relation: Company Name: Phone APPLICATION FOR EMPLOYMENT CITY OF WHITEFISH PO Box 158 Whitefish, MT 59937-0158 (406) 863-2400 ---PAGE BREAK--- City of Whitefish Application for Employment Page 2 of 4 SPECIAL SKILLS: Please describe your skills with hand and power tools, office machines, calculators, copying machines, word processors, computers, computer software, typing and shorthand speed, and proficiency, special secretarial skills, or skills required for the position applied for (attach separate page if needing more room). Title: Dates employed: From To Company Name: Supervisor Name: Address: Supervisor Phone City: State: Salary: Start Current/End Describe work performed: Reason for Leaving: Title: Dates employed: From To Company Name: Supervisor Name: Address: Supervisor Phone City: State: Salary: Start Current/End Describe work performed: Reason for Leaving: EMPLOYMENT HISTORY ---PAGE BREAK--- City of Whitefish Application for Employment Page 3 of 4 Title: Dates employed: From To Company Name: Supervisor Name: Address: Supervisor Phone City: State: Salary: Start Current/End Describe work performed: Reason for Leaving: Additional work experience may be listed on a separate page or resume. LIST ANY LICENSES AND/OR CERTIFICATIONS CURRENTLY HELD: Military Service Information: Branch of Service Active Service: From To ACKNOWLEDGEMENT By submitting this application for employment consideration, I certify that the information provided by me in connection with my application whether on this document or not, is true and complete. I understand that any misstatement, falsification or omission of information may be grounds for refusal to hire or, if hired, termination. I understand that I will be required to sign an authorization to release information if I am considered for employment. I understand that, if employed by the City of Whitefish, I will be required to provide proof of my identity and the legal right to work in the United States within three business days of the date employment begins, to verify my employability in compliance with Federal Law. If offered employment with the City of Whitefish, I understand that I must comply with all of the City's policies, rules and procedures. SIGNATURE OF APPLICANT* DATE *If application is submitted via e-mail, applicant will be required to sign this page if given the opportunity to participate in an interview. Describe your duties and/or special training: SIGN ---PAGE BREAK--- City of Whitefish Application for Employment Page 4 of 4 VETERANS' REEMPLOYMENT PREFERENCE ACT To claim preference under the Veterans' Public Employment Preference Act or the Persons with Disabilities Public Employment Preference Act, complete the following. Providing the following information is voluntary but must be included with the application in order to claim employment preference. This information will be kept confidential and will only be used during the hiring process to apply employment preference. Veterans' Employment Preference provides the addition of 5 percentage points or 10 percentage points to the applicant's score when a numerically scored selection procedure is used. To claim Veterans' Employment Preference you must be a U. S. Citizen and (check one of the boxes below): A Veteran, if You have been separated under honorable conditions, AND 1. You have served more than 180 consecutive days of active federal military duty other than for training in the Army, Air Force, Navy, Marines, or Coast Guard or were a member of the reserves who served on federal military duty during a period of war or in a campaign or expedition for which a campaign badge is authorized, or 2. You are or have been a member of the Montana Army or Air National Guard who has satisfactorily completed a minimum of 6 years' service in armed forces, the last 3 of which have been served in the Montana Army or Air National Guard. A Disabled Veteran, (letter from Veterans Affairs must be submitted) if you have been separated under honorable conditions, AND You have an established Armed Force, service-connected disability OR are receiving compensation, disability retirement benefits, or pension from the U. S. Department of Veteran Affairs or military department, OR, you have received a purple heart. The spouse of a disabled veteran if the veterans' disability prevents him/her from working The un-remarried surviving spouse of a veteran or disabled veteran The mother of a veteran, if 1. The Veteran lost his/her life under honorable conditions while serving in the Armed Forces, OR the Veteran has a service-connected, permanent, and total disability, AND 2. Your SPOUSE is totally and permanently disabled, OR you are the un-remarried widow of the father of the veteran. DISABLED PERSONS' EMPLOYMENT PREFERENCE You may claim Montana Persons with Disabilities Employment Preference as (check one of the boxes below): A person with a disability certified by PHHS (Attach to application). The spouse of a totally (100%) disabled person certified by PHHS and have resided continuously in Montana for at least 1 year immediately before applying for employment (Attach to application). Date of Montana Residency: Sign below if claiming a Veterans Preference or Disabled Preference Signature: Date: SIGN