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Job Application
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Application Information
Name
*
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Street Address
Address Line 2
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*
Email
*
Date Available
*
MM slash DD slash YYYY
What site did you learn about this position?
*
Were you referred to this position by a current City of Pittsburg employee?
*
Yes
No
If yes, what is the current City of Pittsburg employee's name?
Employment Desired?
*
Full Time
Part Time
Days/times available to work
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Mornings
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Hour of work (per week) desired?
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Are you 18 years of age or older?
*
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Enter your age (if younger than 18 years)
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Are you eligible to work in the United States?
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No
Have you ever worked for this organization?
*
Yes
No
Have you ever been convicted of a felony?
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Yes
No
If yes, please explain:
(Number of conviction(s), nature of offense(s), how recently such offense(s) was/were committed, and sentence(s) imposed)
Education
Where did you attend High School and College? (Please include other relevant education information)
School Name
School Address
Did you graduate?
Degree/Major
Military Service
Military Branch
Rank at Discharge
From
To
Are you currently in the Armed Forces?
Yes
No
Employment History (Most Recent)
Company Name (Most Recent)
Company Address (Most Recent)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
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New Hampshire
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New Mexico
New York
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North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Company Phone (Most Recent)
Supervisor (Most Recent)
Your Job Title (Most Recent)
Starting Salary (Most Recent)
Ending Salary (Most Recent)
Responsibilities (Most Recent)
From
To
Reason for Leaving (Most Recent)
May we contact your previous supervisor for a reference? (Most Recent)
Yes
No
Employment History (Second Most Recent)
Company Name (Second Most Recent)
Company Address (Second Most Recent)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
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Angola
Anguilla
Antarctica
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Argentina
Armenia
Aruba
Australia
Austria
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Panama
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Wallis and Futuna
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Åland Islands
Country
Supervisor (Second Most Recent)
Company Phone (Second Most Recent)
Your Job Title (Second Most Recent)
Starting Salary (Second Most Recent)
Ending Salary (Second Most Recent)
Responsibilities (Second Most Recent)
From
To
Reason for Leaving (Second Most Recent)
May we contact your previous supervisor for a reference?
Yes
No
References
Please list at least three professional references.
*
Full Name
Relationship
Company
Phone
Address
Resume Upload
Max. file size: 15 MB.
If you have a resume you'd like to attach, please do so here. This is not required.
Cover Letter
Max. file size: 15 MB.
If you have a cover letter you'd like to attach, please do so here. This is not required.
Supplemental Forms (Optional)
Drop files here or
Select files
Accepted file types: jpg, pdf, doc, png, Max. file size: 15 MB, Max. files: 3.
Certain positions require additional forms to be submitted. You may attach them here.
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment. I understand that the company may require me to successfully complete a pre-employment drug and alcohol test as a condition of employment and that continued employment may be based on the successful completion of similar tests. I understand that the company may as part of the hiring process request an investigative consumer report from a third party entity or agency including information concerning my character, general reputation, personal characteristics, credit records, and mode of living. I may make a written request to the company to provide me with additional information regarding the nature and scope of any such report. I understand that employment with your company is “at will” and nothing in the interview or hiring process, this application, or your company policies are intended to create an employment contract between myself and the company. Employment may be terminated by either party at any time for any reason with or without notice.
Digital Signature
*
Printing your First Name + Middle Initial + Last Name will act as your digital signature.
Date
*
MM slash DD slash YYYY
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