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APPLICATION FOR EMPLOYMENT - CITY OF ROELAND PARK

Notice to Applicant
Complete this application carefully and completely. This information will aid us in evaluating your qualifications. Please attach additional paper and/or documents if necessary to more fully explain your answers. They City of Roeland Park welcomes all qualified applicants without regard to their race, color, religion, gender, national origin, age, veteran status, marital status, medical condition or disability. All offers of employment are conditional upon successfully passing all appropriate examinations and lab tests to include a drug screen. Physical and/or other examinations are used to determine if applicants are qualified to perform the essential functions of the position with or without reasonable accommodation.
The City of Roeland Park is an at-will employer. Either the employee or the City can terminate the employment relationship at-will, with or without cause, at any time.
First Name
Last Name
Street Address
City
State
Zip
Phone Number
Email Address
Social Security #
Previous Addresses in Last 5 Years.
Are you at least 18 years of age?*
1. yes
2. no
Are you eligible to work in the United States?*
1. Yes
2. No
Have you applied with the City of Roeland Park before? If so, when and what position you applied for.
Have you previously been employed with the the City of Roeland Park? If so, indicate dates of employment, position and reason for leaving.
Have you ever been bonded? If yes, what positions?
Have you ever been refused bonding?
1. yes
2. no
Are you a notary public?
1. yes
2. no
Do you have driving record violations?
1. yes
2. no
Valid Driver's License # and State
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POSITION INFORMATION

EDUCATION/TRAINING/SKILLS

EMPLOYMENT HISTORY

REFERENCES

List personal aquaintances who can give reference of your character and ability. Do not include relatives.
Full Name
Phone #
Occupation
Years Acquainted
Full Name
Phone #
Occupation
Years Acquainted
Full Name
Phone #
Occupation
Years Acquainted
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DISCLAIMER & SIGNATURES

ALCOHOL & DRUG SCREENING REQUIREMENT
I understand and agree that, as a condition of employment and, if employed, as a condition of continued employment, I may be required to submit to drug and alcohol screening tests to determine compliance with the City of Roeland Park's policy on Drug and Alcohol abuse. Failure to comply with the testing program will be grounds for disqualification or immediate discharge. I understand that I can review and receive a copy of the City’s Drug and Alcohol screening policy upon request.
Electronic Signature Agreement (Applicant must sign to be considered for any postion with the City)*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Today's Date*
Today's Date
Electronic Signature Agreement (Applicant must sign to be considered for any position with the City)*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Today's Date*
Today's Date

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APPLICATION FOR EMPLOYMENT - CITY OF ROELAND PARK

POSITION INFORMATION

EDUCATION/TRAINING/SKILLS

EMPLOYMENT HISTORY

REFERENCES

DISCLAIMER & SIGNATURES

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