CITY OF RED OAK, IOWA                                                                      Return To: Red Oak Police Department
RED OAK POLICE DEPARTMENT                                                                             PO Box 475
EMPLOYMENT APPLICATION                                                                                   Red Oak, IA 51566-0475

WE CONSIDER APPLICANTS FOR ALL POSITIONS WITHOUT REGARD TO RACE, COLOR, RELIGION, CREED, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, MARITAL OR VETERAN STATUS, SEXUAL ORIENTATION, OR ANY OTHER LEGALLY PROTECTED STATUS.

DATE OF APPLICATION:______________________________________________________
POSITION APPLIED FOR: _____________________________________________________

How did you learn about this position?
____ Web Site          ____ Special Interest Group     ____ Job Service (circle IA or NE or other)
____ School              ____ Job Fair                               ____Walk-in
____ Newspaper      ____ Current City Employee     ____ Other (specify below)

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     Last Name (Please Print or Type)               First Name                                        Middle Name

Social Security Number: ______/______/__________

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     Street Address                                                City                                    State                                Zip Code

(_________)_______________________________(________)__________________________________
     Home Telephone Number                                                          Message or Work Number

If you are under 18 years of age, can you provide required proof
of your eligibility to work?  Yes _____    No _____

Have you ever been employed by the City of Red Oak? Yes _____ No _____
If yes: Dates: __________________________

What is/was your position? ______________________________ Full-Time____ Part-time _____

Are you currently employed? Yes ____   No _____
May we contact your present employer?  Yes _____   No _____

Are you prevented from lawfully becoming employed in this country
because of Visa or Immigration Status?  Yes _____   No _____ Proof of citizenship or immigration status will be required upon employment.

On what date would you be available to begin work? __________________________________________

Are you currently on “lay-off” status and subject to recall?   Yes _____   No _____

Can you travel if a job requires it?  Yes _____ No _____

Have you been convicted of a felony within the last 7 years?  Yes _____   No _____
Conviction will not necessarily disqualify an applicant from employment.

If Yes, please explain: ___________________________________________________________________________________
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EDUCATION: CHECK THE LINE OF YOU HIGHEST GRADE COMPLETED IN EACH SCHOOL CATEGORY

GED 
HIGH SCHOOL GRADUATE OR HIGHEST GRADE COMPLETED 
COLLEGE 
GRADUATE SCHOOL
YES ___ NO ___ 
YES ___ NO___  9 ___ 
10 ___ 11 ___ 12 ___ 
 1 ___ 2 ___ 3 ___ 4___ 
 1 ___ 2 ___ 3 ___ 4 ___

VOCATIONAL TRAINING (IN-SERVICE, BUSINESS, TRADES, TECHNICAL, MILITARY SERVICE SCHOOLS)  PLEASE PROVIDE ADDITIONAL SHEETS IF NECESSARY

NAME AND LOCATION
FROM
MO. DAY. YEAR
 TO
MO. DAY. YEAR
 NUMBER OF HOURS ATTENDED/WEEK
CREDITS EARNED
SUBJECTS OR COURSE OF STUDY
   DATE OF DIPLOMA OR CERTIFICATION

UNIVERSITY AND COLLEGE (UNDERGRADUATE, GRADUATE, DOCTORATE)  PLEASE PROVIDE ADDITIONAL SHEETS IF NECESSARY

NAME AND LOCATION
FROM
MO. DAY. YEAR
TO
MO. DAY. YEAR
NUMBER OF HOURS ATTENDED/WEEK
CREDITS EARNED
     SUBJECTS OR COURSE OF STUDY
 DATE OF DIPLOMA OR CERTIFICATION

EMPLOYMENT EXPERIENCE
Start with your present or last job.  Include any job-related military service assignments and volunteer activities.  You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.  Attach additional sheets as needed.

Firm Name or Employer: ________________________________ Supervisor: _______________________
Address: __________________________________________________________(____)____________
                      Street                                 City                          State              Zip                         Phone Number
Dates of Employment: From: ____________________ To: _____________________
Ending Salary: ________________
Your Job Title: ___________________________________
Reason For Leaving: ___________________________________________________________________
___________________________________________________________________________________
Responsibilities: ______________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

Firm Name or Employer: ________________________________ Supervisor: _______________________
Address: __________________________________________________________(____)____________
                      Street                                 City                          State              Zip                         Phone Number
Dates of Employment: From: ____________________ To: _____________________
Ending Salary: ________________
Your Job Title: ___________________________________
Reason For Leaving: ___________________________________________________________________
Responsibilities: ______________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

Firm Name or Employer: ________________________________ Supervisor: _______________________
Address: __________________________________________________________(____)____________
                      Street                                 City                          State              Zip                         Phone Number
Dates of Employment: From: ____________________ To: _____________________
Ending Salary: ________________
Your Job Title: ___________________________________
Reason For Leaving: ___________________________________________________________________
Responsibilities: ______________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Firm Name or Employer: ________________________________ Supervisor: _______________________
Address: __________________________________________________________(____)____________
                      Street                                 City                          State              Zip                         Phone Number
Dates of Employment: From: ____________________ To: _____________________
Ending Salary: ________________
Your Job Title: ___________________________________
Reason For Leaving: ___________________________________________________________________
Responsibilities: ______________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Firm Name or Employer: ________________________________ Supervisor: _______________________
Address: __________________________________________________________(____)____________
                      Street                                 City                          State              Zip                         Phone Number
Dates of Employment: From: ____________________ To: _____________________
Ending Salary: ________________
Your Job Title: ___________________________________
Reason For Leaving: ___________________________________________________________________
Responsibilities: ______________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

LIST PROFESSIONAL, TRADE, BUSINESS OR CIVIC ACTIVITIES AND OFFICES HELD.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:________________________________________________________
___________________________________________________________________________________
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___________________________________________________________________________________
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___________________________________________________________________________________
Indicate any foreign languages you can speak, read and/or write
Fluent 
Good 
Fair
Speak 
      
Read 
      
Write 
    

 
 
 
 

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

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Describe any job-related training received in the United States military.
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PERSONAL REFERENCES:
PLEASE PROVIDE PERSONAL REFERENCES (EXAMPLES: NEIGHBORS, CO-WORKERS,,ETC.)

____________________________________________________________________________________________
 NAME                                                                                                             TELEPHONE NUMBER
____________________________________________________________________________________________
 STREET ADDRESS                                                 CITY                              STATE                       ZIP
____________________________________________________________________________________________
 NAME                                                                                                             TELEPHONE NUMBER
____________________________________________________________________________________________
 STREET ADDRESS                                                 CITY                              STATE                       ZIP
____________________________________________________________________________________________
 NAME                                                                                                             TELEPHONE NUMBER
____________________________________________________________________________________________
 STREET ADDRESS                                                 CITY                              STATE                       ZIP
____________________________________________________________________________________________
 NAME                                                                                                             TELEPHONE NUMBER
____________________________________________________________________________________________
 STREET ADDRESS                                                 CITY                              STATE                       ZIP
 
 










APPLICANT’S STATEMENT

I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed one year.  Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.  It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the employer.

___________________________________________   _____________________________________
                                   Signature                                                                                       Date
 
 




APPLICANT’S AUTHORIZATION TO RELEASE INFORMATION
REFERENCES,  PERSONAL HISTORY, CRIMINAL HISTORY AND DRIVING HISTORY MAY BE CHECKED ON ALL APPLICANTS WHO ARE UNDER FINAL CONSIDERATION FOR SELECTION.

As an applicant for a position with the City of Red Oak, I hereby authorize the investigation of my past and present work, character, education, military, driving history and police records as well as fingerprint, credit, and criminal checks to ascertain any and all information which may be pertinent to my employment qualifications.  I authorize all past and present employers, educational institutions, references, law enforcement agencies and any other relevant parties to release information, and thereby, release them from all liability for providing and using such information.
Any offer of employment with the City of Red Oak will be conditional pending the outcome of reference and criminal checks.

Printed Name: ________________________________________________

Applicant Signature: ___________________________________________ Date: ___________________

Notary: _____________________________________________________Date: ___________________
 
 











FOR DEPARTMENTAL USE ONLY

Date Application, Resume’ and Fingerprints Submitted: ________________________________________

Position (s) Applied For Is Open: Yes _____   No _____

Position (s) Considered For: _____________________________________________________________
____________________________________________________________________________________________

Interview Date: ________________________________________

Testing Date, if applicable: _______________________________

Investigating Officer: ___________________________________

Background Investigation Completed: _____/_____/_____

Was applicant hired: Yes ____           No ____

If “yes”, date of hire and position: ________________________________________________________

NOTES:
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