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Personal Information

The City of Crestwood is an equal opportunity employer and considers all applicants for employment without regard to race, color, religion, sex, age, ancestry, national origin, disabled or veteran status.
First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
Are You a Veteran?*
If yes, branch of service:
Date entered service:
Date entered service:
Date discharged from service:
Date discharged from service:
Are you legally eligible to work in the United States?*
1. Yes
2. No
Have you ever been convicted, fined, imprisoned, or placed on probation, or have you ever been ordered to deposit collateral for alleged breach or violation of any law, police regulations or ordinance except minor traffic violations?
1. Yes
2. No
If yes, please provide details:
Are any of your relatives/friends employed by the City of Crestwood?*
1. Yes
2. No
If yes, please state their name and position/department
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Position Information

Which position are you applying for?*
Type of employment desired*
1. Full Time
2. Part Time
3. Summer/Seasonal
After reading the job description, to the best of your knowledge, would you be able to perform all the essential functions of the position, with or without reasonable accommodations?*
1. Yes
2. No
Salary desired
Hours of work (per week) desired
On what date would you be available for work?
On what date would you be available for work?
If part-time, what days and hours are you available to work?
How did you hear about the position?
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Education

High School
Name*
Address
Did you graduate?*
Post-Secondary Schooling
Name
Address
Attended From/To
Attended From/To Start Date
—
Attended From/To End Date
Did you graduate?
Total Hours Attended
Degree Received
Other information
Additional Schooling
Name
Address
Degree/Certification Earned
List any additional training, certificates, skills, honors, or awards you would like to be considered:*
Please describe any equipment you can operate related to this position:
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Employment History

(From Most Recent)
Employer 1:*
Position*
Address
Phone Number
Supervisor's name
Dates of Employment*
Dates of Employment Start Date
—
Dates of Employment End Date
Starting Rate of Pay
Final Rate of Pay
Duties/Responsibilities*
Reason for leaving*
May we contact your previous supervisor for a reference?
1. Yes
2. No
Employer 2:*
Position*
Address
Phone Number
Supervisor's Name
Dates of Employment*
Dates of Employment Start Date
—
Dates of Employment End Date
Starting Rate of Pay
Final Rate of Pay
Duties/Responsibilities*
Reason for leaving*
May we contact your previous supervisor for a reference?
1. Yes
2. No
Employer 3:
Position
Address
Phone Number
Supervisor's Name
Dates of Employment
Dates of Employment Start Date
—
Dates of Employment End Date
Starting Rate of Pay
Final Rate of Pay
Duties/Responsibilities
Reason for leaving
May we contact your previous supervisor for a reference?
1. Yes
2. No
Have you ever been discharged or forced to resign?
1. Yes
2. No
If yes, give name and address of employers, date of your discharge or forced resignation, and the reason therefore below:
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References

Please list three professional references.
Contact Name 1:*
Relationship:
Years known:
Address:
Phone:
Contact Name 2:
Relationship:
Years known:
Address:
Phone:
Contact Name 3:
Relationship:
Years known:
Address:
Phone:
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Disclaimer & Signature

I hereby certify that all statements made on or in connection with this application are true and complete to the best of my knowledge and belief. I understand and agree that any misstatements or omissions of material facts will cause forfeiture on my part of all rights to employment by the City of Crestwood.
I do hereby authorize all Federal, State or Local Government Agencies, all Law Enforcement Agencies, the Veterans Administration, Military Agencies, State and Federal Tax Bureaus, Credit Bureaus, Schools and Universities to furnish the City of Crestwood, any and all available information regarding me in order that they may determine my suitability for work.
I hereby authorize the City of Crestwood to make such investigations and inquiries as to my character, employment record, education records including transcripts, credit histories and conviction records as may be deemed necessary in arriving at an employment decision. I hereby release employers, schools, law enforcement agencies and persons from all liability for any damage whatsoever that may ensue from furnishing the same to the City of Crestwood.
I voluntarily consent to a thorough investigation of my past employment and activities. I give the City of Crestwood the right to make checks on my background and financial history, if applicable, and release from all liability or responsibility all persons, companies or corporations supplying such information.
A photocopy, Xerox, emailed or faxed copy of this authorization will be considered as effective and valid as the original.
Before signing, please check to insure that all questions have been answered in a thorough manner. An incomplete application may result in the application being rejected or delayed, which could result in a lost job opportunity.
Applicant Signature*
Today's date*

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