Score & Timekeeper PT - Seasonal - City of Marietta, GA

First Name*

Last Name*

Email Address*

Phone*

Address*

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How many years of experience do you have?*

Do you possess a valid Commercial Driver License (CDL)?*

Are you legally authorized to work in the United States pursuant to Federal and State immigration laws?* YesNo

Will you now, or at any time in the future, require sponsorship for any type of employment visa status?* YesNo

Have you ever been employed by the City of Marietta / BLW?* YesNo

If yes:
Position Held Department Separation Date

Do you have any relatives currently employed by the City of Marietta / BLW?* YesNo

If yes:
Name Relationship Department

Employment Information
START WITH YOUR CURRENT OR MOST RECENT JOB. Please input N/A on all required but non-applicable fields.

Employer Name and Address*

Hire Date*

Separation Date*

Job Title*

Starting Pay Rate*

Final Pay Rate*

Number of Employees Supervised

Reason for leaving:*

Supervisor's Name*

Supervisor's Phone Number*

May we contact for reference?* YesNo

Employer Name and Address*

Hire Date:*

Separation Date:*

Job Title*

Starting Pay Rate*

Final Pay Rate*

Reason for leaving*

Supervisor's Name*

Supervisor's Phone Number*

May we contact for reference?* YesNo

Employer Name and Address

Hire Date

Separation Date

Job Title

Starting Pay Rate

Final Pay Rate

Number of Employees Supervised

Reason for leaving

Supervisor Name

Supervisor's Phone Number

May we contact for reference? yesNo

Skills & Training
List any special skills, qualifications, or certifications you have gained which relate to the position for which you are applying:

Accommodations
Are you able to perform the essential functions of this job with or without accommodations?* YesNo

I authorize a full background investigation of all information contained in or attached to this application including contacting any or all employers, personal references or others who may have knowledge of my experience, skills, and personal attributes. I certify that any entity or individual who releases any record consistent with this authorization shall not be held accountable for releasing any record or records and expressly release any entity or individual from any or all liability which could be incurred as a result of releasing said record or records.

I have read the foregoing and understand its contents. I also understand that the City of Marietta/BLW requires that I verify as true and accurate all information submitted by me on any application for employment. By my submission of this signed application, I am declaring all information submitted is true and correct. I further understand that misrepresentation or omission of facts or information may result in disqualification for the position applied for, or if employed, disciplinary action up to and including dismissal.

Required* I Agree

Signature*

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Score & Timekeeper PT - Seasonal

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