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Have you ever been employed with the City of Bessemer City? * Yes No
If so, which department?
Have you ever applied for a position with the City of Bessemer City? * No Yes
If so, indicate the position and when you applied.
Are you willing to accept the salary/wage within the advertised range? * Yes No Third Choice
Are you now or were you previously related in any way to a City employee? * No Yes
If yes, give the name, relationship, and department.
Are you able to perform all duties of the job you have applied for? * Yes No
Have you ever been convicted of a felony? * No Yes Third Choice
If yes, please explain. Note- a conviction record WILL NOT necessarily exclude you from employment. Factors such as age at time of offense, rehabilitation efforts, length of time since the offense, and nature of the crime will be taken into consideration.
Are you an American Citizen or do you currently have authorization to work in the U.S.? * Yes No
Did you receive any of your education or employment experience under another name? * No Yes
If yes, please explain:
Indicate the highest school year completed: * 8 9 10 11 12 13 14 15 16 17 18 18 or more
What is the name of the high school you attended? Please include the City and State of the school. *
Have you received your high school diploma or equivalent? * Yes No
Please indicate any colleges or universities you attended. Please include: 1) Name and Location, 2) Attendance (month and year started, month and year completed), 3) Did you graduate?, 4) Credit Hours, 5) Name of Your Degree, Diploma, Certificate Earned, Etc., 6) Major and Minor
Please indicate any graduate or professional schools you attended. Please include: 1) Name and Location, 2) Attendance (month and year started, month and year completed), 3) Did you graduate?, 4) Credit Hours, 5) Name of Your Degree, Diploma, Certificate Earned, Etc., 6) Major and Minor
Please indicate any technical institutes or internships you attended. Please include: 1) Name and Location, 2) Attendance (month and year started, month and year completed), 3) Did you graduate?, 4) Credit Hours, 5) Name of Your Degree, Diploma, Certificate Earned, Etc., 6) Major and Minor
Please list any knowledge, skills, or abilities you have that you feel are applicable to the position for which you are applying. Include skills with equipment, machinery, software, etc. you can operate. *
Please record your work history below (past 3-5 positions, if applicable). Please indicate the following for each job: 1) Job Title, 2) Starting Salary, 3) Last Salary, 4) Date Employed, 5) Date Separated, 6) Employer or Company, 7) Employer or Company Address, 8) Name and Title of most current supervisor, 9) Length of employment, 10) Duties in order of importance, 11) reason for leaving or desiring a change *
Have you had disciplinary action taken against you in the past 12 months? * No Yes
If yes, please explain (a "yes" does not automatically disqualify you)
Have you ever been dismissed or forced to resign from any job held? * No Yes
If yes, please explain (a "yes" does not automatically disqualify you)
May we contact your present employer for reference prior to an interview (if granted)? * Yes No Currently not employed
What is your gender? Male Female Other
What is your ethnicity? White Black Hispanic Asian or Pacific Islander American Indian or Alaskan Native
How did you learn about this opening? Internet Newspaper Word of Mouth Other Print Material
SELECTIVE SERVICE REGISTRATION- If male and age 18-26, have you registered for Selective Service? Yes No N/A
