Form Center

2. *required information
4. Primary Position Applied For*
   -- Select One --Patrol OfficerEvents Center Patron Services SupervisorFacilities and Pool Maintenance TechnicianOperations and Maintenance Technician IProcurement and Grant Reporting ManagerRecreation CoordinatorSystems Administrator IAdministrative Assistant (Rec/HR:Part-Time, Benefits)Ute Event Center Server/Bartender (Part-Time)Theater & Event Technician I (Part-Time)Theater & Event Technician II (Part-Time)Adult Basketball Referee (Seasonal)Youth Basketball Referee (Seasonal)
6. Other Position(s) Applied For

   1. Patrol Officer
   2. Events Center Patron Services Supervisor
   3. Facilities and Pool Maintenance Technician
   4. Operations and Maintenance Technician I
   5. Procurement and Grant Reporting Manager
   6. Recreation Coordinator
   7. Systems Administrator I

   1. Administrative Assistant (Rec/HR: Part-Time, Benefits)
   2. Ute Event Center Server/Bartender (Part-Time)
   3. Theater & Event Technician I (Part-Time)
   4. Theater & Event Technician II (Part-Time)
   5. Adult Basketball Referee (Seasonal)
   6. Youth Basketball Referee (Seasonal)
8. First Name*
10. Middle Name
12. Last Name*
14. Contact Information
16. Address
18. Street*
20. City*
21. State*
22. Zip*
24. Mailing Address, if different
26. Street
28. City
29. State
30. Zip
32. List phone number(s) the City can use to contact you
34. Phone Number*
36. Phone Number
38. Phone Number
40. E-mail Address*
42. Education/Skills/Licenses
44. High School
46. Name*
48. Location (City and State)*
50. Did you earn a diploma or GED?*

    1. Yes
    2. No
52. College
54. Name
56. Location (City and State)
58. Course of Study
60. What type of degree did you earn?
62. Graduate School
64. Name
66. Location (City and State)
68. Course of Study
70. What type of degree did you earn?
72. Other
74. Name
76. Location (City and State)
78. Course of Study
80. What type of degree or certificate did you earn?
82. Other
84. Name
86. Location (City and State)
88. Course of Study
90. What type of degree or certificate did you earn?
92. Skills/Licenses
94. Scholarships/Academic Honors/Awards
96. List any language abilities that might help you perform the job for which you are applying
98. How many words per minute can you type with accuracy?
100. List software programs that you can use proficiently*
102. List equipment or office machines you can operate with a high degree of skill*
104. List professional licenses that you hold*
106. Driver's License
108. Number
109. State
110. Class
111. Expiration Date
     Expiration Date
113. Employment Experience (list most recent first)
115. If you have no work experience, type "n/a" into all the fields for "Current or Most Recent Employer"
117. Name of Current or Most Recent Employer*
119. Street*
121. City*
122. State*
123. Zip*
125. Job Title*
127. Your supervisor's name*
128. Your supervisor's phone number*
130. Employment Starting Date*
     Employment Starting Date
131. Employment Ending Date*
     Employment Ending Date
133. How many people did you supervise?*
135. Duties*
137. Why did you leave this job?*
139. 
     
141. Name of Previous Employer
143. Street
145. City
146. State
147. Zip
149. Job Title
151. Your supervisor's name
152. Your supervisor's phone number
154. Employment Starting Date
     Employment Starting Date
155. Employment Ending Date
     Employment Ending Date
157. How many people did you supervise?
159. Duties
161. Why did you leave this job?
163. 
     
165. Name of Previous Employer
167. Street
169. City
170. State
171. Zip
173. Job Title
175. Your supervisor's name
176. Your supervisor's phone number
178. Employment starting date
     Employment starting date
179. Employment ending date
     Employment ending date
181. How many people did you supervise?
183. Duties
185. Why did you leave this job?
187. Other Information
189. List volunteer or community work that might be helpful in determining your eligibility for employment*
191. How did you learn that the City of Rifle was hiring for this position?*
193. If previously employed by the City of Rifle, list job(s) and dates
195. If any relatives by blood, marriage, or adoption work for or serve in an elected or appointed position for the City of Rifle, list name(s)
197. Are you willing to work*

     1. Overtime
     2. Shifts
     3. Part-time
     4. Weekends
     5. Temporary
199. What date would you be available for work?*
201. Attachments
203. You may attach résumés, cover letters or other documentation to your application, but résumés are not accepted in place of completed application forms.
205. Attachment #2
206. Attachment #3
208. Certification and Consent
210. By my signature placed below, I affirm under the penalty of perjury, that the information provided in this employment application (and accompanying resume, if any) is provided voluntarily, is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment, even if the omission or falsehood does not directly relate to my job or is not discovered for many years.*

     1. Yes
     2. No
212. I understand that this application does not, by itself, create a contract of employment. I understand and agree that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time subject to the provisions of the Personnel Policy Manual as the same may be amended. I understand that no person is authorized to change any of the terms mentioned in this employment application form.*

     1. Yes
     2. No
214. I give my permission for a complete post-offer/pre-employment physical examination, including a drug screening exam and x-rays, and I consent to the release to the City of Rifle of any and all medical information, as may be deemed necessary by the City of Rifle, in judging my capability to do the work for which I am applying.*

     1. Yes
     2. No
216. I authorize the investigation of all statements contained in this application. I also authorize the City of Rifle to contact my present employer, past employers, and any listed references.*

     1. Yes
     2. No
218. I authorize a search of my criminal justice record and, if required for the position for which I am applying, consent to a polygraph test and/or credit check.*

     1. Yes
     2. No
220. I authorize any persons, schools, current employers and organizations named in this application form to provide the City of Rifle with relevant information and opinions that may be useful to the City of Rifle in making a hiring decision, and I release such persons and organizations from any legal liability for any such information furnished.*

     1. Yes
     2. No
222. Name*
223. Date*
Leave This Blank:


225. Submit

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