APPLICATION FOR EMPLOYMENT

City of Kalama - PO Box 1007, Kalama, WA 98625

Phone:  (360) 673-3265;    Fax:   (360) 673-4560

* The City of Kalama considers applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

* The City of Kalama considers applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Date of Applicaton

Position(s) Applied For:

How Did You Hear About Us?

How Did You Hear About Us?

Advertisement

Employment Agency

Friend

Relative

Walk-In

Other: If other, type text here.

New Standard Question

New Standard Question

Last Name:

First Name:

Middle Name:

Street Address:

City, State, and Zip Code:

Phone Number:ext.

Secondary Phone Number:ext.

Email Address:

If you are under 18 years of age, can you provide required proof of your eligibility to work?

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes

No

Have you ever filed an application with the City of Kalama before?

Have you ever filed an application with the City of Kalama before?

Yes

No

Are you currently employed?

Are you currently employed?

Yes

No

If currently employed, may we contact your current employer?

If currently employed, may we contact your current employer?

Yes

No

Not Applicable

Are you prevented from lawfully becoming employed in this country because of VIsa or Immigration Status?

(Proof of citizenship or immigration status will be required upon employment.)

Are you prevented from lawfully becoming employed in this country because of VIsa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment.)

Yes

No

On what date would you be available for work?

On what date would you be available for work?

Are you available to work:

Are you available to work:

Full Time

Part Time

Shift Work

Temporary

Are you currently on "lay-off" status and subject to recall?

Are you currently on "lay-off" status and subject to recall?

Yes

No

Can you travel if the job requires it?

Can you travel if the job requires it?

Yes

No

Have you been convicted of a felony within the last 7 years?

(Conviction will not necessarily disqualify an applicant from employment.)

Have you been convicted of a felony within the last 7 years? (Conviction will not necessarily disqualify an applicant from employment.)

Yes

No

If Yes, please explain.

If Yes, please explain.

EDUCATION

 

	Name and Address of School	Course of Study	Years Completed	Diploma/Degree
Elementary School	EDUCATION	EDUCATION	EDUCATION	EDUCATION
High School	EDUCATION	EDUCATION	EDUCATION	EDUCATION
Undergraduate School	EDUCATION	EDUCATION	EDUCATION	EDUCATION
Graduate School	EDUCATION	EDUCATION	EDUCATION	EDUCATION
Other (Specify)	EDUCATION	EDUCATION	EDUCATION	EDUCATION

Indicate any foreign languages you can speak, read, and/or write.

	Fluent	Good	Fair
Speak	Indicate any foreign languages you can speak, read, and/or write.	Indicate any foreign languages you can speak, read, and/or write.	Indicate any foreign languages you can speak, read, and/or write.
Read	Indicate any foreign languages you can speak, read, and/or write.	Indicate any foreign languages you can speak, read, and/or write.	Indicate any foreign languages you can speak, read, and/or write.
Write	Indicate any foreign languages you can speak, read, and/or write.	Indicate any foreign languages you can speak, read, and/or write.	Indicate any foreign languages you can speak, read, and/or write.

Describe any specialized training, apprenticeship, skills, and extra-curricular activities.

Describe any specialized training, apprenticeship, skills, and extra-curricular activities.

Describe any job-related training received in the United States Military.

Describe any job-related training received in the United States Military.

ADDITIONAL INFORMATION

Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.

ADDITIONAL INFORMATION Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience.

Special Skills

How many words per minute can you type?

Special Skills How many words per minute can you type?

Check below any office equipment you can operate or skills you have in the programs listed.

Check below any office equipment you can operate or skills you have in the programs listed.

PC

Calculator

Fax

MS Excel

MS Front Page

MS Outlook

MS Power Point

MS Publisher

MS Word

Word Perfect

Indicate Equipment Operated:

	Production/Mobile Machinery (list):	Other (list):
1.	Indicate Equipment Operated:	Indicate Equipment Operated:
2.	Indicate Equipment Operated:	Indicate Equipment Operated:
3.	Indicate Equipment Operated:	Indicate Equipment Operated:
4.	Indicate Equipment Operated:	Indicate Equipment Operated:
5.	Indicate Equipment Operated:	Indicate Equipment Operated:

State any additional information you feel may be helpful to us in considering your application.

State any additional information you feel may be helpful to us in considering your application.

NOTE TO APPLICANTS:  Do not answer this question unless you have been informed about the requirements of the job for which you are applying.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?  If the job opening has been posted, a description of the activities involved in the job or occupation is available with the job posting.  Otherwise, you may contact City Hall for the current job description.

NOTE TO APPLICANTS: Do not answer this question unless you have been informed about the requirements of the job for which you are applying. Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? If the job opening has been posted, a description of the activities involved in the job or occupation is available with the job posting. Otherwise, you may contact City Hall for the current job description.

Yes

No

Have not read job description

REFERENCES

Reference 1:

REFERENCES Reference 1:

Name:

Phone Number:ext.

Address:

Reference 2:

Reference 2:

Name:

Phone Number:ext.

Address:

Reference 3:

Reference 3:

Name:

Phone Number:ext.

Address:

List professional, trade, business, or civic activities and offices held.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry,, disability, or other protected status.

List professional, trade, business, or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry,, disability, or other protected status.

EMPLOYMENT EXPERIENCE

Start with your present or last job.  Include any job-related military service assignments and volunteer activities.  You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status.

Employer No. 1

EMPLOYMENT EXPERIENCE Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status. Employer No. 1

Employer

Address

Telephone Numberext.

Job Title

Date Employed From

Date Employed To

Starting Hourly Rate/Salary

Ending Hourly Rate/Salary

Work Performed

Reason for Leaving

Employer No. 2

Employer No. 2

Employer

Address

Telephone Numberext.

Job Title

Date Employed From

Date Employed To

Starting Hourly Rate/Salary

Ending Hourly Rate/Salary

Work Performed

Reason for Leaving

Employer No. 3

Employer No. 3

Employer

Address

Telephone Numberext.

Job Title

Date Employed From

Date Employed To

Starting Hourly Rate/Salary

Ending Hourly Rate/Salary

Work Performed

Reason for Leaving

Employer No. 4

Employer No. 4

Employer

Address

Telephone Numberext.

Job Title

Date Employed From

Date Employed To

Starting Hourly Rate/Salary

Ending Hourly Rate/Salary

Work Performed

Reason for Leaving

Employer No. 5

Employer No. 5

Employer

Address

Telephone Numberext.

Job Title

Date Employed From

Date Employed To

Starting Hourly Rate/Salary

Ending Hourly Rate/Salary

Work Performed

Reason for Leaving

If you need additional space, please continue on an attachment.

APPLICANT'S STATEMENT

I certify that the answers given herein are true and complete to the best of my knowledge.  

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

By submitting this application I authorize the following:

APPLICANT'S STATEMENT I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. By submitting this application I authorize the following:

Authorization to check references.

Authorization to conduct a background investigation, including criminal conviction record.

Authorization to check credit scores (for positions that handle money).

Authorization to conduct a Motor Vehicle Record check.

Authorization to verify job-related licenses/certifications.

This application for employment shall be considered active for a period of time not to exceed 45 days.  Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the CIty is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.  It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of the City.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the City.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the CIty is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of the City. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the City.

Signature of Applicant:

Date:

If you have questions on how to use this electronic application, email cityclerk@kalama.com.

*** To receive a copy of your application, be sure and indicate your email address in the space provided below.***

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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