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Employment Application

Employment Application

Application Information

Please complete the entire application
First Name
Middle Name
Last Name
Address
City
State/Province
Zip/Postal
Country
Last 4 Digits of your Social Security Number
Are there other names under which you have worked or attended school? *
If you have worked or attended school with another name, please list for reference checking purposes.
Are you legally authorized to work in the U.S.? *
(If hired, you will be required to provide proof or work authorization)
Are you at least 18 years old? *
If not, your employment will be subject to verification that you meet state/federal minimum age requirements for the type of work you are applying for and having obtaining a valid work permit.
Have you applied with the City of Geneseo before? *
If you have applied with the City of Geneseo before please list when.
Have you ever worked here before? *
If you have worked for the City of Geneseo before please list when.
City employees are required to live no more than twenty (20) miles from City Hall within six months of employment (one year for sworn officers). If offered employment, are you willing to comply with this requirement within six months of employment? *

Employment History

Start with most recent. Click 'Add Employer' to add an additional employer.

Past Employer

Address *
Address
City
State/Province
Zip/Postal
Country
Detail your primary duties while working for this employer.
May we contact as a reference *

Education

High School

To add an additional high school click the 'Add' button.
Your High School's Name
(City, State)
Diploma or Degree Received *

College

To add an additional college click the 'Add' button.
Your College's Name
(City, State)
Diploma or Degree Received

Graduate

To add an additional graduate school click the 'Add' button.
Your Graduate School's Name
(City, State)
Diploma or Degree Received

Other

(specify)
Your School's Name
(City, State)
Diploma or Degree Received

Training Courses

List any relevant training programs completed. Click 'Add' to add additional training courses.

Course Details

Employment References

List individuals familiar with your job qualifications (no family / relatives).
Address
Address
City
State/Province
Zip/Postal
Country
Your relationship to this reference
How long have you known this reference?

Address
Address
City
State/Province
Zip/Postal
Country
Your relationship to this reference
How long have you known this reference?

Address
Address
City
State/Province
Zip/Postal
Country
Your relationship to this reference
How long have you known this reference?

License(s)

To add additional license(s) click the 'Add' button.

License Details

Are you licensed with any group, association or society relating to the job for which you are applying?
Group, Association, or Society registration or license number
Group, Association, or Society registration or license number issuing state.
Date the License expires

All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired.

I authorize the city to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purposes of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment. This report may contain information about me concerning my character, general reputation, personal characteristics, and mode of living, among other relevant things. This information may be obtained from a variety of sources, including but not limited to, government agencies, past employers, personal interviews with those who know me and others.

I understand that upon receiving a job offer, a criminal background check, a physical examination and drug screening may be requested. (Note: If this is a job requirement, you will be notified). I also understand that upon employment, I must furnish proof of eligibility to live and work legally in the United States.

I also understand that the City will require me within six months of employment to reside no more than twenty (20) miles from City Hall. An employee's failure to live within the boundaries of the residency requirements may constitute grounds for immediate dismissal.

Regardless of whether or not I become employed by the City, I recognize that this application is not and should not be considered a contract of employment. I understand that employment at the City is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or the company's, unless specifically provided otherwise in a written employment contract. I further understand that no City employee or representative has the authority to enter into a contract regarding the duration of terms and conditions of employment other than an officer or official of the City, and then only by means of a signed, written document.

Type in your full name as your signature to accept the terms of application.
Date of Application, must be today's date.
Maximum upload size: 104.86MB
Maximum upload size: 104.86MB
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