Apply for a Job

Your Name *

Address *

City *

State *

Zip Code *

Phone Number *

How did you learn about the position? (circle one, if other explain)

How did you learn about position?

Position(s) Applied For: *

Employment Preference

Salary Desired:

Legal Authorization *

I am legally authorized to work in the United States

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

Have you ever been employed with the city before?

Have you ever applied to the city before?

On what date would you be available for work? *

Do you have any restrictions on working any days or times or overtime, if needed? *

Work Restrictions *

Able to meet attendance requirements? *

I am able to meet the attendance requirements for the job?

Are you currently working in any capacity for another government agency or entity that offers PERS (MS State Retirement) benefits *

For whom and how many hours are you working? *

Are you able to meet all the essential requirements of the job for which you are applying? *

Is there reasonable accommodation that can be provided to allow you to perform the essential functions for the job? *

Certain relationships between applicants for City positions, City employees or elected officials could constitute violations of State law or City policy if the applicant were hired. In order to assist the city in determining if a prohibited relationship exists, please identify below any and all persons related to you birth, marriage, or otherwise who are employed by the City of Senatobia or that are elected officials:

Person(s) related to me (if any)

Education Details

Education Background

Highest-Grade Completed *

School Name and Location *

College Level *

Certification Achieved *

List any work-related certifications or licenses you currently possess

List equipment and tools that you can operate and or any specific or specific skills/qualifications that you have for the position(s) in which you are applying

Words per Minute

Background Information

DRIVER’S LICENSE NUMBER *

Drivers License State *

During the past ten years, have you ever been discharged, suspended, or asked to resign from any position?

If yes, please explain *

For the purpose of verifying information on this application, have you ever worked or attended school under a different name at any of the organizations you have listed? *

If yes, please explain *

Have you ever been convicted of a crime (felonies and/or misdemeanors) that has not been expunged, erased, sealed, pardoned, annulled, eradicated by statute or court order, or dismissed upon condition of probation? *

Please explain below *

Personal Information

List three people, other than relatives, who have knowledge of your character and/or ability.

Reference 1 *

Ref 1 Address *

Reference 2 *

Ref 2 Address *

Reference 3 *

Ref 3 Address *

Employment History

IMPORTANT:

LIST BELOW ALL PRESENT AND PAST EMPLOYMENT, FOR THE PAST TEN YEARS, BEGINNING WITH THE MOST RECENT JOB HELD. Attach additional sheets if necessary.
TAKE TIME TO FILL IN THE DATA CAREFULLY AND COMPLETELY. ONE OF THE WAYS QUALIFICATIONS ARE ACCESSED IS BASED ON THE DATA YOU ENTER ON YOUR EMPLOYMENT HISTORY.
INDICATE IF YOU ARE NOW UNEMPLOYED OR IF YOU HAVE NEVER BEEN EMPLOYED.

Company Name *

Position *

Telephone *

Address

Starting date *

Ending date *

Supervisor Name and Title

If currently employed, may we contact your supervisor?

Yes

Summary of Duties

Add another Job?

Yes

Company Name *

Position *

Telephone *

Address

Starting date *

Ending date *

Supervisor Name and Title

If currently employed, may we contact your supervisor?

Yes

Summary of Duties

Add a 3rd Job?

Yes

Company Name *

Position *

Telephone *

Address

Starting date *

Ending date *

Supervisor Name and Title

If currently employed, may we contact your supervisor?

Yes

Summary of Duties

Other Details

Do you have a non-compete clause, a confidentiality obligation, or a contractual obligation with your current or former employer that has not yet expired that could impact your ability to work at the City of Senatobia in the position for which you have applied? *

Yes

No

If you have answered "yes" to this question, please contact the HR Department, and provide complete copies thereof.

Attach a Resume

Choose File

PLEASE READ CAREFULLY AND INITIAL EACH PARAGRAPH BEFORE SIGNING

I have disclosed all information that is relevant and should be considered applicable to my candidacy for employment. Any misrepresentation or omission made on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer's service, whenever it is discovered.

Disclosure Initials *

I understand, where permissible under applicable state and local law, after receiving a conditional offer of employment, I may be subject to a pre-employment medical examination which could include a pre-employment drug test, and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with the City of Senatobia.

Medical Initials *

I hereby certify that the information given by me is true in all respects. I authorize the City of Senatobia and its representatives to contact my prior employers, and all other references provided for the purpose of verifying the information I have supplied and release same from any liability resulting from the information released. I authorize employers, schools, and other people named on this application to provide any information or transcripts requested..

Contact Initials *

I understand employment with the City of Senatobia is also contingent on providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.

Document Initials *

I understand that this application is current for 60 days. At the conclusion of this time, if I have not heard from the City of Senatobia and still wish to be considered for employment, it will be necessary to fill out a new application.

60 Day Initials *

I expressly understand and agree that, if employed, my employment, having no specified term, is based upon mutual consent, and may be terminated at will, with or without cause, by either party (the employer or me) without prior notice to the other, unless otherwise prohibited by law.

Termination Initials *

I understand that no representation, whether oral or written, by any representative or agent of the City of Senatobia, at any time, shall constitute an implied or expressed contract of employment, nor guarantee of continued employment, and I acknowledge that the City of Senatobia reserves the right to modify company policies, procedures, manuals and similar documents at any time. I further understand that no representative or agent of the City of Senatobia has the authority to enter into an agreement for employment for any specified period or to make any employment contract or agreement contrary to the foregoing, except in a written agreement with me signed by the City of Senatobia Board of Aldermen.

Rep Initials *

I certify, under the penalty of perjury, that all of the above information is true and complete, and I understand that any falsification or omission of information may result in denial of employment or, if hired, may result in termination regardless of the time lapse before discovery. I VOLUNTARILY WAIVE AND RELEASE PRIOR EMPLOYERS FROM ANY AND ALL LIABILITY FOR PROVIDING INFORMATION IN CONNECTION WITH THIS APPLICATION. MY SIGNATURE IS EVIDENCE THAT I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.

Signature *

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Apply for a Job

Education Details

Background Information

Personal Information

Employment History

Other Details

PLEASE READ CAREFULLY AND INITIAL EACH PARAGRAPH BEFORE SIGNING

City of Senatobia

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