CITY OF TARRANT
PUBLIC WORKS DEPARTMENT
Employment Application
Applicant Information
Full Name:
Date:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
State
Phone:
ZIP Code
Email
Date Available:
Desired Salary:$
Social Security No.:
Position Applied for:
YES
NO
YES
Are you a citizen of the United States?
YES
NO
YES
NO
If yes, what is your
license number?
Do you have your drivers license?
Have you ever been convicted of a felony?
If yes, when?:___________________________________
If yes, explain:
Education
High School:
Location:
YES
From:
To:
College/
Trade:
NO
Did you graduate?
Diploma:
Location:
YES
From:
To:
NO
If no, are you authorized to work in the U.S.?
Did you graduate?
NO
Degree:
References
Please list references who are not related to you.
Full Name:
Relationship:
Company:
Phone:
Full Name:
Relationship:
Company:
Phone:
1
Full Name:
Relationship:
Company:
Phone:
Previous Employment
Company:
Phone:
Address:
Supervisor:
Starting Salary:$
Job Title:
Ending Salary:$
Responsibilities:
From:
To:
Reason for Leaving:
YES
NO
May we contact your previous supervisor for a reference?
Company:
Phone:
Address:
Supervisor:
Starting Salary:$
Job Title:
Ending Salary:$
Responsibilities:
From:
To:
Reason for Leaving:
YES
NO
May we contact your previous supervisor for a reference?
Military Service
Branch:
From:
Rank at Discharge:
To:
Type of Discharge:
If other than honorable, explain:
Disclaimer and Signature
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.
I understand that applicants may be tested for illegal drugs and that employees may be screened for intoxication
on the job or for use of illegal drugs.
I certify that I have reliable transportation, and that I will be responsible for maintaining transportation to work for
all assigned shifts.
Signature:
Date:
2