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Applicant Information

First Name*
Middle Initial
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
Are you age 18 or older?*
1. Yes
1. No
If No, list age:
POLICE POSITIONS ONLY: Are you age 21 or older?
1. Yes
1. No
If no, list age:
Are you authorized to work in the United States?*
1. Yes
1. No
If No, List Permanent Residency or Work Permit Number:
Have you ever plead guilty or been convicted of a crime that would effect your fitness to perform this job? (Exclude misdemeanor traffic violations. Conviction of a crime does not automatically bar you from employment)*
1. Yes
1. No
If yes, list date:
List offense:
Are there any charges pending in this state or other states which may inhibit your ability to perform in this position?
1. Yes
1. No
If yes, explain:
Is any additional information relative to change of name, use of assumed name, maiden name, or nickname necessary to conduct a check of your work record?
1. Yes
1. No
If yes, explain:
If this position requires a Driver's License do you have a valid Driver's License?
1. Yes
1. No
License Number:
Expiration Date:
State of Issuance:
Do you claim Veteran's preference?
1. Yes
1. No
If yes, Upload DD214 (separation papers)
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Position / Job Information

Education and Training

The information provided in this section will determine your qualificatoins for this position. Be as thorough as possible in describing yor education and work experience. Vague or incomplete answers will not be interpreted in your favor.
High School
Address
Did you graduate?
1. Yes
2. No
College1
Address
Did you graduate?
1. Yes
1. No
Dates
Dates Start Date
—
Dates End Date
Degree
College2
Address
Did you graduate?
1. Yes
1. No
Dates
Dates Start Date
—
Dates End Date
Degree
Other
Address
Dates
Dates Start Date
—
Dates End Date
Degree
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Related Work Experience

Are you licensed, registered or certified in a profession or trade?
1. Yes
1. No
If yes, identify the profession or trade name:
License / Permit / Certification Number:
State of Issuance:
Expiration Date
Expiration Date
Identify any other educational experiences you have had which are pertinent to this position. Include workshops, seminars, military or vocational training, computer software, etc. which are not listed above. Indicate time involved (hours per week, number of weeks, number of credits, etc.)
List any relevant certificates, licenses or registrations you posses or for which you are eligible. Include expiration dates.
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Employment History

(List last three employers starting with most recent)
Company
Phone Number
Address
Supervisor
May we contact your previous supervisor for a reference?
1. Yes
1. No
Job Title
Starting Salary $
Ending Salary $
Employed From / To Date:
Employed From / To Date: Start Date
—
Employed From / To Date: End Date
Reason for leaving
Responsibilities
Company
Phone Number
Address
Supervisor
May we contact your previous supervisor for a reference?
1. Yes
1. No
Job Title
Starting Salary $
Ending Salary $
Employed To / From Date
Employed To / From Date Start Date
—
Employed To / From Date End Date
Reason for Leaving
Responsibilities
Company
Phone Number
Address
Supervisor
May we contact your previous supervisor for a reference?
1. Yes
1. No
Job Title
Starting Salary $
Ending Salary $
Employed From / To Date
Employed From / To Date Start Date
—
Employed From / To Date End Date
Reason for Leaving
Responsibilities
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Unemployment

(List all periods of unemployment)
From / To Date
From / To Date Start Date
—
From / To Date End Date
How did you spend this time?
From / To Date
From / To Date Start Date
—
From / To Date End Date
How did you spend this time?
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References

(Please list three professional references)
Full Name*
Relationship*
Company*
Phone Number*
Address*
City*
State*
Zip Code*
Full Name
Relationship
Company
Phone Number
Address
City
State
Zip Code
Full Name
Relationship
Company
Phone Number
Address
City
State
Zip Code
Upload Resume
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Disclaimer & Signature

I hereby certify that this application is complete to the best of my knowledge for the periods of employment listed and all information given is true and contains no misrepresentations. I am aware that all statements submitted on this application are subject to investigation and verification. I understand that any withholding of information, misrepresentation or falsification of statements on this application or on city medical forms could result in rejection for employment, or if employed, termination from the city at any time.
I authorize and release from liability all employers, persons, schools, law enforcement agencies and other organizations to provide information requested by the City of Huron in its processing of this application.
I also understand that nothing in this application or in the granting of an interview is intended to create an employment contract. I have received no promise regarding employment and I understand that no such promise or guarantee is binding on the City of Huron. If an employment relationship is established, my employment is at-will and I understand that I have the right to terminate my employment at any time and that the City of Huron has a similar right.
Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*
Permission to Research Driving History, Sexual Offender Registry and Criminal Background
I do hereby authorize a review of and full disclosure of vehicle operator license status, driving history records, sexual offender registry and criminal history records concerning myself to any duly authorized agent of the City of Huron whether the said records are public, private or confidential.
The intent of this authorization is to give my consent for full and complete disclosure of my vehicle operator license status and driving history. I understand that any information obtained during the investigation of my vehicle operator license status and driving history records, which is developed directly or indirectly, in whole or in part upon this release authorization, may be considered in determining my suitability for employ by the City of Huron.
The intent of this authorization is to give my consent for full and complete investigation of my criminal history records. I understand that any information obtained during the investigation of my criminal history records, which is developed directly or indirectly, in whole or in part upon this release authorization, may be considered in determining my suitability for employ by the City of Huron.
If this position involves working with or around minor children, then the intent of this authorization is to give my consent for investigation of any pertinent history that may be shown in the county and state sexual offender registry.
If this position requires the operation of a vehicle controlled by Commercial Drivers License (CDL) regulations, I hereby authorize full disclosure of my previous drug and alcohol testing results from past employers where I participated in a federally mandated drug and alcohol testing program controlled by the US Dept. of Transportation, Federal Highway Administration. This permission includes the right for the City of Huron
Drug/Alcohol Program Manager to discuss my drug and alcohol testing history with representatives of previous employers – as permitted by federal regulations. Any information discussed related to Federal Motor Carrier Controlled Substances and Alcohol Use and Testing regulations will be held as confidential information for the use of the City Drug/Alcohol Program Manager.
I also certify that any person(s) who may furnish such information concerning me shall not be held accountable for giving this information. I do hereby release said person(s) from any and all liability that may be incurred as a result of furnishing such information.
Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*
Parent / Legal Guardian Signature
If applicant is 17 years of age or under, then a parent or legal guardian must sign.
The City of Huron, in accordance with state and federal laws, does not discriminate on the basis of age, race, color, ancestry, national origin, creed, religion, sex, marital status, disability or political affiliation. The City of Huron fully subscribes to the provisions of the American With Disabilities Act and will attempt in its employment process to make any reasonable accommodations necessary to assist qualified persons with disabilities.

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Unemployment

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