Print legibly in blue or black ink NAME: DATE: ____________ POSITION APPLYING FOR:_____________________ PRESENT ADDRESS: CITY: STATE:_______ ZIP:_________ PERMANENT ADDRESS: ____________________CITY:________________ STATE:_______ZIP:_________ PHONE: _____________ARE YOU UNDER 18? YES / NO SOCIAL SECURITY NUMBER: _______________ REFERRED BY:______________________________ COUNTY OF PERMANENT RESIDENCE: ________________ HIGH SCHOOL ATTENDED: ______________________________GRADUATION DATE ________ COLLEGE ATTENDED: ________________________Major/Degree___________GRADUATION DATE______ NUMBER PARK PREFERENCE (1-MOST FAVORED, 4 LEAST FAVORED) Buffalo Trace Park _______ Rhoads Pool________ South Harrison Park_________ Hayswood ________ HAVE YOU WORKED FOR THIS OR ANY PARK DEPARTMENT BEFORE? YES / NO IF YES, LIST PRIOR EXPERIENCE: PARK POSITION HELD YEARS WORKED ________________________________________________________________ HAVE YOU EVER USED A CASH REGISTER BEFORE? YES / NO IF YES, LIST WHERE LIST ALL CERTIFICATIONS HELD (i.e.: CPR, FIRST AID, ETC.) DO YOU HAVE OR PLAN TO HAVE ANOTHER JOB OR SCHOOL SCHEDULE THAT WOULD INTERFERE WITH A FLEXIBLE WORK SCHEDULE FROM MEMORIAL DAY TO LABOR DAY? YES / NO IF YES, DESCRIBE HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES / NO WHAT YEAR? IF YES, WHAT WAS THE NATURE OF THE CHARGE? DO YOU HAVE ADEQUATE TRANSPORTATION TO AND FROM WORK? YES / NO DATE AVAILABLE TO INTERVIEW IN CORYDON______________ DATE AVAILABLE TO BEGIN WORKING _____________________ FORMER EMPLOYERS (LIST, STARTING WITH LAST ONE FIRST) DATE NAME OF EMPLOYER SALARY POSITION REASON FOR LEAVING FROM __________________________________ ______________ _______________ _________________________________ TO FROM __________________________________ ______________ _______________ _________________________________ TO FROM __________________________________ ______________ _______________ _________________________________ TO FROM __________________________________ ______________ _______________ _________________________________ TO REFERENCES: GIVE BELOW THE NAMES OF THREE PERSONS, NON- RELATIVES, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR NAME:_________________________________________PHONE NUMBER:_______________ ADDRESS _______________________________________________________________________ BUSINESS______________________YEARS ACQUAINTED _______ NAME:_________________________________________PHONE NUMBER:_______________ ADDRESS _______________________________________________________________________ BUSINESS______________________YEARS ACQUAINTED _______ NAME:_________________________________________PHONE NUMBER:_______________ ADDRESS _______________________________________________________________________ BUSINESS______________________YEARS ACQUAINTED _______ DO YOU HAVE ANY PHYSICAL PROBLEMS PRECLUDING YOU FROM PERFORMING CERTAIN TASKS? YES / NO IF YES, DESCRIBE: IN CASE OF EMERGENCY NOTIFY:____________________________PHONE:______________________ ADDRESS:________________________________________________RELATIONSHIP:________________________ HAVE YOU INCLUDED A RESUME? YES / NO PLEASE READ: I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages, be terminated at any time without any previous notice. DATE:____________SIGNATURE OF APPLICANT_______________________________________ EQUAL OPPORTUNITY EMPLOYER |
Employment Application
| Harrison County Parks and Recreation 245 Atwood, Suite 120 Corydon, Indiana 47112 |
| Please mail all applications to |
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| POSITION APPLYING FOR __________________________________ |