Title of Job Applying for:

Date*

Applicant's Name

Applicant's Street Address

City

State

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Zip Code

Home Phone Number

Cell Phone Number

Email address:

Are you under 18 years of age?*

Yes

No

Social Security Number*

If you are hired for a position, can you show proof of U.S. Citizenship?*

Yes

No

Are you a registered alien?

Yes

No

Registration Number?

Driver's License Number*

State*

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Type*

Have you ever been employed by the City of Canyon?

Yes

No

What department?

Date employed

Date Available for Work

Are you able to work: (check all that apply)

Full-time Part-time

Shift-work

Are there any restrictions to the hours you can work?

Yes

No

If yes, please explain:

Are you related to any employee of the City of Canyon?

Yes

No

If yes, whom:

Relationship:

IF YOU WOULD LIKE TO SUBMIT A RESUME, PLEASE EMAIL IT TO mhickman@canyontx.com. You will still need to complete all fields on this application. If it is not applicable, please indicate with N/A.

EDUCATION

GED

Yes

No

High School

School Name

School Address

Number of years attended

Graduate

Yes

No

University

University Name

University Address

Number of years attended

Graduate

Yes

No

Major

Degree

Other Education

Military Service Record:

Are you a Veteran

Yes

No

If yes, Branch

Date Entered

Date Discharged

Special Training

Rank

Have you ever been convicted, pled guilty or no contest to a felony offense?

Yes

No

(Important: for purposes of employment with the City of Canyon, "convictions" include sentenced to confinement, paid fine, time served, placed on probation (including deferred adjudication) and court-ordered restitution.)

If yes, please explain.

A conviction record will not necessarily disqualify you from employment. Your case will be considered in relationship to the requirements of the position.

Have you reviewed the job description for the position which you are applying?

Yes

No

If yes, do you have any physical, mental, or medical impairments that will impede your ability to satisfactorily perform the job applied for?

Yes

No

If so, what type(s) of job accommodations will enable you to perform the job?

Where did you hear of this job opening?

EMPLOYMENT HISTORY : (start with the most recent)

Employer Name:

May we contact this Employer?

Yes

No

Employment Hire Date to Separation Date:

Address, City, State, Zip

Phone Number: (area code first)

Job Title:

Job Duties:

Annual Salary (starting and ending)

Reason for Leaving:

Employer Name:

May we contact this Employer?

Yes

No

Employment Hire Date to Separation Date:

Address, City, State, Zip

Phone Number: (area code first)

Job Title:

Job Duties:

Annual Salary (starting and ending)

Reason for Leaving:

Employer Name:

May we contact this Employer?

Yes

No

Employment Hire Date to Separation Date:

Address, City, State, Zip

Phone Number: (area code first)

Job Title:

Job Duties:

Annual Salary (starting and ending)

Reason for Leaving:

Employer Name:

May we contact this Employer?

Yes

No

Employment Hire Date to Separation Date:

Address, City, State, Zip

Phone Number: (area code first)

Job Title:

Job Duties:

Annual Salary (starting and ending)

Reason for Leaving:

Supplementary Training / Experience: List other training and experience

Qualifications Summary: In detail, list the qualifications and skills you possess.

Upon submission of this application, I certify that the answers given herein are true and complete to the best of my knowledge. I hereby authorize the City of Canyon the right to investigate all statements contained in this application. In the event of employment, I understand that false statements on the application shall be grounds for dismissal. I also understand that by submitting this application, upon notification I am subject to a pre-employment physical examination and drug and alcohol testing, and further, will be subject to a criminal background check. I agree to immediately notify the City of Canyon if I am convicted of, receive deferred adjudication in, or otherwise plead guilty or no contest to a felony, or any crime involving dishonesty or breach of trust, while my application is pending or during my period of employment, if hired. The City of Canyon is an At-Will Employer and no municipal employee or official has the right to offer permanent employment.

Applicants Full Name

Date:

AN EQUAL OPPORTUNITY EMPLOYER
Qualified applicants are considered for all positions without regard to race, color, gender, religious or political preference, national origin, handicap, age or veterans status.