Application For

Employment


We consider applicants for all positions without regard to race, color, religion, gender, national origin, the presence of Non-job-related medical condition or disability, or any other legally protected status. We will not refuse to hire a disabled Applicant who is qualified to perform the essential functions of the job with reasonable accommodation. If you need Assistance completing this form, help will be provided to you.

Position Applying For: Date:

Last Name: First Name: Middle Initial:
Social Security Number:
Address: City: State: Zip Code:
Telephone(Home): Telephone(Work):
Have you ever been employed with the City of Russell before? Dates Employed
Are you currently employed? May we contact your present employer?
Are you prevented from lawfully becoming employed in this country because of visa or immigration status?
On what date would you be available to work?
High School or GED: Diploma or Degree:
College: Diploma or Degree:
Technical: Diploma or Degree:
List any Special job related skills and qualifications acquired from employment, military, or other experience.

List Three References:
Name: Address: Phone:
Name: Address: Phone:
Name: Address: Phone:

Prior two (2) years employment references: Start with your present or last job. Include any military service assignments and job-related volunteer activities You may Exclude organizations which indicate race, color, religion, gender, national origin, disablity, or other protected status.
Employer: Address: Telephone:
Job Title: Dates Employed: Hourly Rate/Salary:
Duties: Reason for Leaving:

Employer: Address: Telephone:
Job Title: Dates Employed: Hourly Rate/Salary:
Duties: Reason for Leaving:

Employer: Address: Telephone:
Job Title: Dates Employed: Hourly Rate/Salary:
Duties: Reason for Leaving:

Employer: Address: Telephone:
Job Title: Dates Employed: Hourly Rate/Salary:
Duties: Reason for Leaving:

Employer: Address: Telephone:
Job Title: Dates Employed: Hourly Rate/Salary:
Duties: Reason for Leaving:

Employer: Address: Telephone:
Job Title: Dates Employed: Hourly Rate/Salary:
Duties: Reason for Leaving:

Employer: Address: Telephone:
Job Title: Dates Employed: Hourly Rate/Salary:
Duties: Reason for Leaving:

Employer: Address: Telephone:
Job Title: Dates Employed: Hourly Rate/Salary:
Duties: Reason for Leaving:

Employer: Address: Telephone:
Job Title: Dates Employed: Hourly Rate/Salary:
Duties: Reason for Leaving:

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application of employment as may be necessary in arriving at an employment decision. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. Selected applicants are subject to a pre-employment physical exam and drug testing. Also, in the event of employment, I agree to: A) locate my residence in Russell County within six (6) months from the effective date of employment, and; B) Be subject to random drug and alcohol testing.
By submitting this application online, I agree and consent to the Applicant Statement above.