Form Center

Position Information

Please provide complete and legible information. An incomplete application may affect your consideration for employment. If necessary, attach a separate sheet for additional information. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or handicap, or any other legally protected status. All city employees are “at will employees”.
Date of Application
Date of Application
Position Applied For
Referral Source
1. City Employee
2. Internet
3. Newspaper Ad
4. Workforce
5. Other
If Other, Please Specify
Continue

Personal Information

Employment Experience

Education

High School or GED Equivalent
School Name & Location
Course of Study or Major
Highest Grade Completed
1. 9
2. 10
3. 11
4. 12
Dates Attended
Dates Attended Start Date
—
Dates Attended End Date
College or University
School Name & Location
Course of Study or Major
Highest Grade Completed
1. 1
2. 2
3. 3
4. 4
Dates Attended
Dates Attended Start Date
—
Dates Attended End Date
Vocational or Trade School
School Name & Location
Course of Study or Major
Highest Grade Completed
Dates Attended
Dates Attended Start Date
—
Dates Attended End Date
Graduate School
School Name & Location
Course of Study or Major
Highest Grade Completed
Dates Attended
Dates Attended Start Date
—
Dates Attended End Date
Other (Including Military Training)
School Name & Location
Course of Study or Major
Highest Grade Completed
Dates Attended
Dates Attended Start Date
—
Dates Attended End Date
Note Any Special Coursework, Honors, Activities, Special Projects or Any Other Data That Will Assist Us in Considering Your Application for Employment
List All Licenses You Now Hold (Driver’s License, Commercial Driver's License, Electricians, Etc.)
Special Skills and Qualifications
Please comment on how your prior education and experiences qualify you for the type of employment you are seeking. Detail any past responsibilities and achievements.
Continue |Go Back

Professional References

List Three Professional References (Other Than Those Listed as Current/Previous Supervisor) That We May Contact:
Name
Phone Number
Email Address
Type of Acquaintance
Name
Phone Number
Email Address
Type of Acquaintance
Name
Phone Number
Email Address
Type of Acquaintance
Continue |Go Back

Information Disclosure

I have disclosed all information that is relevant and should be considered applicable to my candidacy for employment.
Initials
I understand, where permissible under applicable state and local law, I may be subject to a pre-employment drug test after receiving a conditional offer of employment, and must receive a negative result for illegal drugs before being permitted to commence work with the City of West Memphis.
Initials
I understand, where permissible under applicable state and local law, I may be subject to a pre-employment medical examination after receiving a conditional offer of employment, and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with the City of West Memphis.
Initials
I hereby certify that the information given by me is true in all respects, I authorize the City of West Memphis and its representatives to contact my prior employers and all others for the purpose of verification of the information I have supplied and release same from any liability resulting from the information released. I authorize employers, schools and other persons named on this application to provide any information or transcripts requested.
Initials
I understand employment with the City of West Memphis is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.
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 (City of West Memphis or me) without prior notice to the other, unless otherwise prohibited by law.
Initials
I understand that no representation, whether oral or written, by a representative or agent of the City of West Memphis, at any time can constitute an implied or expressed contract of employment. I further understand no representative or agent of the City of West Memphis had the authority to enter into an agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other terms or condition of employment other than in a document signed by the Director of Human Resources or an authorized representative.
Initials
I certify, under 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.
Initials
Note: An offer of employment is conditioned upon complying with the City of West Memphis’ requirements including, but not limited to signing a consent form to conduct a background investigation and drug test.
Continue |Go Back

Electronic Signature

My signature is evidence that I have read and agree with the above statements.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. *
1. I Agree.
Applicant's Signature*
Date
Date
Continue |Go Back

Search Forms:

Online General Employment Application

Steps

Position Information

Personal Information

Employment Experience

Education

Professional References

Information Disclosure

Electronic Signature

Applicant Data Record

Contact Us

Follow Us!

Contact Links

Using This Site