City of Garden City - Government

Service Request Type:

Employment Application

Description:

The City of Garden City only accepts applications for positions that are currently open.

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Contact E-Mail:

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First Name:

Middle Intial:

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Last Name:

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Address:

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City:

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State:

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Zipcode:

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Phone Number:

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Date Available to Start:

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Last 4 digits of SSN:

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Position Applying For:

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Salary Desired:

If required, can you provide certification that you are over 18 years of age?

Yes

No

Do you have a legal right to obtain employment in the U.S.

Yes

No

Are you qualified for a Veterans Preference under KSA – 73-201

Yes

No

If you answered YES please complete additional six questions below for Veterans eligibility criteria.

Any person who entered the armed forces before October 15, 1976, and separated from the armed forces under honorable
conditions, if such person served: (i) on active duty during any war (the official dates for war service are April 6, 1917 through
July 2, 1921, and December 7, 1941 through April 28, 1952); (ii) during the period April 28, 1952 through July 1, 1955; (iii) in any
campaign or expedition for which a campaign badge or service medal has been authorized; or (iv) for more than 180 consecutive
days since January 31, 1955, but before October 15, 1976, excluding an initial period of active duty for training under the ‘‘six
month’’ reserve or national guard program."

Any person who entered the armed forces on or after October 15, 1976, and separated from the armed forces under honorable
conditions, if such person was awarded a service medal or campaign badge.

Any person who separated from the armed forces under honorable conditions and has a disability certified by the United States
department of veterans affairs as being service connected, has been issued the purple heart by the United States government or
has been released from active service with a service-connected disability.

The spouse of a veteran who has a 100% service connected disability as determined by the United States department of veteran
affairs.

The widow (who has not remarried) of a veteran who died while, and as a result of, serving in armed forces; and

The spouse of a prisoner of war, as defined by K.S.A. 75-4364, and amendments thereto.

EDUCATION

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Name and Location of High School:

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Last Grade Completed:

GED

Yes

No

Diploma

Yes

No

Name and Location of College:

Semester Hours Completed:

Field of Study:

Degree:

Name and Location of Techinical School:

Clock Hours Completed:

Field of Study:

Certificate:

List any Special Training:

DRIVING RECORD

(to be completed by all applicants for positions requiring operation of motor vehicles)

Drivers License State:

Class of License:

Drivers License Number:

MOTOR VEHICLE ACCIDENTS

List all motor vehicle accidents in which you have been involved as a driver,
within the past five years, including the date and location of accident.

TRAFFIC CONVICTION RECORD

List all traffic convictions in the last five years,
excluding parking violations. List date, offense and court for all convictions.

Have you ever been denied a drivers license, permit or privilege to operate
a motor vehicle?

Yes

No

Has your driver’s license, permit or privilege to operate a motor vehicle
ever been suspended or revoked?

Yes

No

Have you ever been convicted of, or participated in a diversion for Driving Under
the Influence of Alcohol or Drugs?

Yes

No

CONTROLLED SUBSTANCE/ALCOHOL USE TESTING
(To be completed by all applicants seeking a safety sensitive or commercial driver’s license position.)

Have you ever been disciplined by a previous employer for violation
of a controlled substance or alcohol policy?

Yes

No

If yes, describe details:

Have you ever received a positive controlled substance or alcohol test
result administered by a previous employer?

Yes

No

CRIMINAL RECORD

Have you ever been convicted of a felony or misdemeanor? If the
answer is yes, please list date, offense and court for all convictions. The
term convicted includes a guilty plea, a finding of guilt by a judge or jury, or a plea of no contest.

A felony or misdemeanor conviction does not automatically
disqualify you from employment, but the City may consider the
number, nature, seriousness and date of conviction in making employment decisions.

EMPLOYMENT RECORD

LIST ALL POSITIONS HELD FOR THE PAST TEN YEARS STARTING
WITH THE MOST RECENT POSITION. ACCOUNT FOR ALL PERIODS OF
MILITARY SERVICE AND UNEMPLOYMENT. LIST CITY, STATE AND ZIP CODE.

Company Name:

Employed From:

Employed To:

Address:

Starting Salary:

Ending Salary:

Immediate Supervisor:

Telephone Number:

Average Hours Worked Per Week:

Job Title:

Reason For Leaving:

Company Name:

Employed From:

Employed To:

Address:

Starting Salary:

Ending Salary:

Immediate Supervisor:

Telephone Number:

Average Hours Worked Per Week:

Job Title:

Reason For Leaving:

Company Name:

Employed From:

Employed To:

Address:

Starting Salary:

Ending Salary:

Immediate Supervisor:

Telephone Number:

Average Hours Worked Per Week:

Job Title:

Reason For Leaving:

Company Name:

Employed From:

Employed To:

Address:

Starting Salary:

Ending Salary:

Immediate Supervisor:

Telephone Number:

Average Hours Worked Per Week:

Job Title:

Reason For Leaving:

Company Name:

Employed From:

Employed To:

Address:

Starting Salary:

Ending Salary:

Immediate Supervisor:

Telephone Number:

Average Hours Worked Per Week:

Job Title:

Reason For Leaving:

May we contact your present employer?

Yes

No

If no, please explain:

PERSONAL REFERENCES

List three references who are not a relative or former employer.

PERSONAL REFERENCE ONE

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Name:

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Address:

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Home Phone:

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Business Phone:

PERSONAL REFERENCE TWO

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Name:

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Address:

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Home Phone:

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Business Phone:

PERSONAL REFERENCE THREE

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Name:

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Address:

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Home Phone:

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Business Phone:

Drug and Alcohol Testing:

All applicants for safety sensitive or commercial driver’s license positions with the City shall be required to submit to a drug and alcohol test after a conditional offer of employment has been made to the applicant. The results of the drug and alcohol test will be provided to the City. If you are currently using controlled substances, you will not be eligible for employment. If you use controlled substances after you are employed or alcohol in violation of City policy, you will be subject to disciplinary action, including dismissal.

For All Applicants: Please read carefully before signing.

I hereby certify that the statements made by me in this application and all related information which I have provided are true, accurate and complete to the best of my knowledge. I understand that if I provide false, inaccurate or incomplete information I will not be eligible for employment or, if I am hired, I will be subject to dismissal, regardless of the date on which the City discovers the violation of its policy regarding application form dishonesty.

In connection with my application for employment with the City, I expressly authorize the release to the City of any records or information which may refer or relate to my application for employment, including, but not limited to, records of schools, law enforcement or criminal justice agencies and previous employers. I hereby release and discharge the City and any other person, firm, agency, corporation or previous employer from any and all claims and liability which I may have or ever claim to have relating to information provided to the City as part of my application for employment.

If I am seeking employment for a safety sensitive position or one utilizing a commercial driver’s license, I hereby authorize the release of any random, reasonable suspicion or post-accident controlled substance or alcohol test results in the possession of any previous employer.

If I am offered and accept employment with the City, I understand that my employment is at will, and that my employment may be terminated at any time, either by me, or by the City. Neither this application, nor any employment documents required to be signed by the City shall constitute a contract of employment for a specific term, and I further understand that no employee handbook, written policy or procedure, shall constitute a contract of employment, either express or implied.

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Electronic Signature:

By typing your name you are submitting an electronic signature.