VILLAGE OF BALTIMORE – EMPLOYMENT APPLICATION

WE OFFER EQUAL EMPLOYMENT OPPORTUNITY TO ALL BASED UPON INDIVIDUAL MERIT & WITHOUT REGARD TO RACE, COLOR, AND RELIGION
NAME: LAST FIRST: MIDDLE:
ADDRESS: NUMBER, STREET, ETC.
CITY OR TOWN: STATE: ZIP CODE:
PHONE: FAX:
APPLYING FOR: (GIVE SPECIFIC JOB TITLE(S))
 
1   EMPLOYER NAME: PHONE:
ADDRESS: CITY: STATE: ZIP:
SUPERVISOR'S NAME & TITLE: DATE HIRED: TERMINATED:
FINAL WAGE: $ LEFT, WHY? JOB TITLE:
YOUR DUTIES/SKILLS:
 
2   EMPLOYER NAME: PHONE:
ADDRESS: CITY: STATE: ZIP:
SUPERVISOR'S NAME & TITLE: DATE HIRED: TERMINATED:
FINAL WAGE: $ LEFT, WHY? JOB TITLE:
YOUR DUTIES/SKILLS:
 
3   EMPLOYER NAME: PHONE:
ADDRESS: CITY: STATE: ZIP:
SUPERVISOR'S NAME & TITLE: DATE HIRED: TERMINATED:
FINAL WAGE: $ LEFT, WHY? JOB TITLE:
YOUR DUTIES/SKILLS:
 
EDUCATIONSCHOOL NAME/LOCATIONDEGREE/STUDIEDYEARS COMPLETED
HIGH SCHOOL
TRADE SCHOOL
COLLEGE/VO-TECH
OTHER SPECIAL TRAINING OR EDUCATION:
 
ADDITIONAL INFORMATION
  1. ARE YOU AT LEAST 18 YEARS OF AGE? YES  NO
  2. HAVE YOU EVER BEEN CONVICTED OF A CRIME(S)? YES  NO
    IF YES, EXPLAIN THE NATURE OF THE OFFENSE, DATE, AND PENALTY:
  3. DO YOU HAVE ANY RELATIVES IN OUR EMPLOY? YES  NO
    IF YES, GIVE NAME(S), RELATIONSHIP(S), AND WORK LOCATION(S):
  4. HAVE YOU EVER WORKED FOR OR APPLIED TO VILLAGE OF BALTIMORE BEFORE? YES  NO
    IF YES, GiVE DATE, LOCATION, AND TYPE OF WORK:
  5. IS THERE ANY LEGAL REASON WHY YOU CANNOT BE EMPLOYED IN THIS COUNTRY? YES  NO
    IF YES, EXPLAIN:
IMPORTANT – READ THE FOLLOWING CERTIFICATION AND AGREEMENT CAREFULLY.

IN MAKING THIS APPLICATION FOR EMPLOYMENT, I CERTIFY THAT THE STATEMENTS I HAVE MADE ARE TRUE, COMPLETE AND CORRECT, AND I AGREE THAT ANY WILLFULLY FALSE STATEMENTS OR MISREPRESENTATIONS HEREIN, WHENEVER DISCERNED, ARE JUST CAUSE FOR VILLAGE OF BALTIMORE EITHER TO REFUSE OR TERMINATE MY EMPLOYMENT. FURTHER, I AUTHORIZE ANY SCHOOL OR FORMER EMPLOYER TO DISCLOSE TO VILLAGE OF BALTIMORE UPON REQUEST ANY INFORMATION THEY MAY HAVE AS TO MY RECORD, PERFORMANCE, AND ATTENDANCE AND WILL HOLD SUCH SCHOOLS AND EMPLOYERS HARMLESS FOR SUCH DISCLOSURE. I AGREE TO TAKE THE REQUIRED DRUG SCREENING TEST FOLLOWING AN OFFER OF EMPLOYMENT. I UNDERSTAND THAT THIS APPLICATION BECOMES VOID AFTER 30 DAYS UNLESS RENEWED PERSONALLY OR IN WRITING BY ME. I HAVE READ AND DO UNDERSTAND AND SUBSCRIbE TO THIS CERTIFICATION AND AGREEMENT.

IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF VILLAGE OF BALTIMORE. I ALSO AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT MY OPTION OR AT THE OPTION OF THE VILLAGE OF BALTIMORE. I UNDERSTAND THAT NO EMPLOYEE OR REPRESENTATIVE OF VILLAGE OF BALTIMORE, OTHER THAN THE VILLAGE ADMINISTRATOR OR MAYOR, HUMAN RESOURCVES AND ADMINISTRATION HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT GUARANTEEING MY EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, NOR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.

YOUR NAME: TODAY'S DATE: