Position Applying For:

PT Lifeguard Aquatic Custodian PT Truck Driver for Construction Crew

Contact Information

Full Legal Name*

Street Address 1*

Street Address 2

City*

State*

Zipcode*

Phone 1*

Phone 2

Email Address:

Education Information

Highest Grade Completed*

5 6 7 8 9 10 11 12

Years of Post High School Education*

0 1 2 3 4 5 6 7

If you did not complete High School, do you have a High School Equivalency Diploma?

Yes No n/a

Use the following boxes to list, "Name & Location of Institution", "Hours Completed", "whether your Degree was received", "Major or Specialty", and "Dates Attended".

1) High School

2) Associate's

3) Bachelor's

4) Master's +

Experience

Have you ever worked for the Town of Christiansburg?*

Yes No

Dates

May we contact your most recent employer? *

Yes No

Starting with the most recent, describe the last two paid, military and applicable voluntary experience. Highlight your knowledge, skills and abilities which best describe your qualifications for this position. You may list significantly different jobs within the same organization as separate items.

Job 1

Job Title*

Employer*

Street Address 1*

Street Address 2

City*

State*

Zipcode*

Phone*

Type of Business*

Immediate Supervisor*

Supervisor's Job Title*

Dates Worked*

Hours/Week*

Duties*

Equipment Used*

Reason For Leaving*

Your Name if Different From Present

Job 2

Job Title*

Employer*

Street Address 1*

Street Address 2

City*

State*

Zipcode*

Phone*

Type of Business*

Immediate Supervisor*

Supervisor's Job Title*

Dates Worked*

Hours/Week*

Duties*

Equipment Used*

Reason For Leaving*

Your Name if Different From Present

Use this space for any additional information you think would help us to evaluate your application. Include training, seminars, workshops, special achievements or specialized skills.

Drivers License Type

Expiration Date

State

Note: A copy of your driving record will be required prior to employment.

Certificate or other authorization to practice a trade or profession. Please include the type, expiration date, and who the the certificate is granted by (license board).

References

List the Names, Addresses, Phone and Relationships of three persons not related to you who know your qualification.

1*

2*

3*

Miscellaneous

Select which job status you would accept*

Full-Time Part-Time

For purposes of compliance with the Immigration Reform and Control Act, are you legally eligible for employment in the United States? Under the Immigration Reform and Control Act of 1986, you will be required to fill out a certification verifying that you are eligible to be employed and verifying your identity. Further, you will be required to provide documentation to that effect should you be employed.*

Yes No

Are you a Veteran?*

Yes No

Dates

Have you ever been convicted of a law violation(s), including moving traffic violations but excluding offenses committed before your eighteenth birthday which were finally adjudicated in a Juvenile Court or under a Youth Offender Law?*

Yes No

If Yes, list all and explain

When will you be able to start work?*

Certification - Each Application Requires Current Date and Electronic Signature

I HEREBY CERTIFY THAT ALL ENTRIES ON BOTH SIDES AND ATTACHMENTS ARE TRUE AND COMPLETE, AND I AGREE AND UNDERSTAND THAT ANY FALSIFICATION OF INFORMATION HEREIN, REGARDLES OF TIME OF DISCOVERY, MAY CAUSE FORFEITURE ON MY PART TO ANY EMPLOYMENT IN THE SERVICE OF THE TOWN OF CHRISTIANSBURG. I UNDERSTAND THAT ALL INFORMATION ON THIS APPLICATION IS SUBJECT TO VERIFICATION AND I CONSENT TO REFERENCES, FORMER EMPLOYERS, LAW ENFORCEMENT AGENCIES, CREDIT BUREAUS AND EDUCATIONAL INSTITUTIONS BEING CONTACTED REGARDING THIS APPLICATION. I FURTHER AUTHORIZE THE TOWN OF CHRISTIANSBURG TO RELY UPON AND USE, AS IT SEES FIT, ANY INFORMATION RECEIVED FROM SUCH CONTACTS. INFORMATION CONTAINED ON THIS APPLICATION MAY BE DISSEMINATED TO OTHER AGENCIES, NONGOVERNMENTAL ORGANIZATIONS OR SYSTEMS ON A NEED-TO-KNOW BASIS FOR GOOD CAUSE SHOWN AS DETERMINED BY THE TOWN MANAGER OR DESIGNEE.

Date

Applicant Signature

*APPLICATIONS WILL NOT BE ACCEPTED UNLESS A JOB VACANCY HAS BEEN ANNOUNCED BY THE TOWN OF CHRISTIANSBURG. IN ACCORDANCE WITH VIRGINIA PUBLIC RECORDS MANAGEMENT GUIDELINES, EMPLOYMENT APPLICATIONS WILL NOT BE KEPT ON FILE FOR FUTURE REFERENCE.

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