Cornelia Employment Application

Date *

Position applied for *

Name *

Social security # *

Address *

Telephone # *

Mobile! pager! other phone # *

Have you worked for the City of Cornelia before? *

If yes, provide dates and positions held

Type of employment desired *

Full Time
Part Time
Seasonal
Other

Hours desired *

Day
Evening
Night

Are you able to meet the attendance requirements of the position? *

Date available for work *

Desired salary *

Can you provide the documentation required to verify your legal right to work in the US? *

Are you under 18? *

If yes, can you furnish a work permit? *

Are you able, with or without reasonable accommodation to perform all of the essential functions/ duties of the job for which you are applying? *

Is there any reason you cannot be at work each and every schedule day and work your full shift? *

Do you have a valid driver's license? *

Have you ever been convicted of a felony?* *

*Answering yes does not bar employment. Factors such as date, seriousness and nature of violation, rehabilitation and position applied for will be taken into account If yes, please provide dates and details

If yes, please provide dates and details *

Educationl Training

Choose last grade completed

Elementary! Middle *

High School *

College *

Technicall Vocational school attended *

College attended *

Other training/ certifications), skills, and qualifications *

Employment History (Current or Last)

Provide the following information, starting with the most recent.

Do you have any Work Experience? *

References

1: Personal Reference Name

Telephone

Number of years known

2: Personal Reference Name

Telephone

Number of years known

Print

Name

Social security #

Applicant Statement

READ BEFORE SIGNING

I certify that all statements on this application are true and hereby grant the City of Cornelia permission to verify such answers. I hereby authorize all my employers personal references, licensing authorities, and educational institutions to furnish any information to verify the accuracy of all information provided by me in this application, resume, or interview and release all such persons from liability are damages incurred as a result of inquiry and furnishing this information. I waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand and agree that: In the course of employment processing, a criminal background, motor vehicle record and for some positions a credit report check will be conducted. I also understand that the City of Cornelia will periodically check criminal history information and motor vehicle records at any time during my employment without seeking additional consent.

Date of birth is required for background check. Please provide monthl dayl year: *

Falsification of facts on this application is grounds for rejection of this application. I will be subject to termination at any time should false information be discovered.
If hired, I will be required to provide proof of identity and legal authority to work in the us. If hired, I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. No supervisor or representative of the employer is authorized to make any assurances to the contrary and no implied, oral or written agreements are valid unless they are in writing and signed be the City Manager.
If employed, employment will be conditional upon the satisfactory completion of a 90 day probationary period and satisfactory completion of all pre-employment processing, including reference checks, drug testing, and physical exam to be an employee This application remains current for 90 days.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement

Signature of Applicant

Date *

The City of Cornelia provides equal employment opportunities to all applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or status as a Vietnam-era or special disabled veteran in accordance with applicable federal laws. The City of Cornelia will only hire authorized workers, regardless of national origin.
The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way.

Please complete the section below:

Date *

Applying for which job?

Gender *