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Month
Day
Year
Position Applying to
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Applicant Information
Name
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Middle
Last
Suffix
Address
Street Address
Address Line 2
City
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Sudan
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Switzerland
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Thailand
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Tonga
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Tuvalu
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Venezuela
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Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
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Required
Phone
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Required
Social security number
*
Required
Are you at least 18 years old?
*
Required
Yes
No
Job Type
Full Time
Part Time
Are you legally eligible to work in the United ?
*
Required
Yes
No
Do you have a valid driver license?
*
Required
Yes
No
If the position you are applying for requires operation of a motor vehicle, list any traffic violations you have incurred during the past 5 years.
Have you ever applied or been employed by the City of Palmview?
*
Required
Yes
No
Date you can start?
MM slash DD slash YYYY
Education
Name of School
# of Years Completed
Major or Degree
Special Skills or Qualifications
List any other skills
Previous Employment
Employer Name
First
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Last Job Title
*
Required
Salary
*
Required
Supervisor Name
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company.
Reason for leaving (Be specific)
References
Please list any references other than relatives.
Name
E-mail
Telephone #
Please list any references other than relatives.
Resume
Max. file size: 25 MB.
Please attach your resume
Cover Letter
Max. file size: 25 MB.
Please attach your cover letter
Consent
*
Required
***Applicant Please Read the Following Carefully***
Note: A Criminal Background Check and Drug Test will be conducted on all prospective employment applicants and other volunteer
placements. A criminal record does not constitute an absolute bar to employment factors such as age at the time of the offense;
rehabilitation efforts, how recent and seriousness of the crime will be taken into account.
CERTIFICATION
I hereby certify that answers given herein are true and complete to the best of my knowledge and agree that if employed, any
misrepresentation, falsification or omission of facts thereon shall justify my dismissal. I hereby authorize the City of Palmview to fully
investigate my record and work qualifications either before or after my employment by the City of Palmview and to facilitate such
investigation, I also hereby authorize any persons, office, agency or source, having information and knowledge about my
personal, employment, military, educational, driving record, criminal, credit or financial history; prior work related injury
information, physical screening, drug screening and other related matters as may be necessary in arriving at an employment
decision to furnish and release such information to the City of Palmview. I hereby release employers, schools, agencies, or persons
from all liability in responding to inquiries in connection with my application. In submitting this application, I understand that it
becomes the property of the City of Palmview and will not be returned or altered by City staff. I hereby understand and
acknowledge that, any employment relationship with the City if of an “at will” nature, which means any employee may be removed by
the City Manager, by the head of a department or by other appointing office at any time in accordance with applicable law.
I agree
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