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Personal Information

First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
Answer this question only after reviewing a description of the job(s) applied for*
Are you able to perform the functions of the job(s) for which you are applying; with or without accommodation?
1. Yes
2. No
If you are 18 years of age or younger and still in High School, can you furnish a work permit?
1. Yes
2. No
If hired, on what date can you start work?
Have you ever worked for the City of Lancaster?*
1. Yes
2. No
If yes, please indicate department, position and dates employed.*
Where did you hear about this position?
1. Advertisement
2. Friend
3. Employment Agency
4. Other
If other, please specify?
Are you eligible to work in the United States?*
1. Yes
1. No
Type of employment desired*
1. Full Time
2. Part Time
1. Internship
2. Temporary
1. Shift Work
1. Overtime
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We employ only United States citizens and aliens lawfully authorized to work in the United States. In compliance with Immigration Reform and Control Act of 1986, we require all new employees to complete the employment eligibility verification form (I-9) and to provide legally sufficent documentation of identiy and employment eligibility.
Are you legally eligible to work in the United States?
1. Yes
1. No
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High School Graduate?
1. Yes
1. No
Name and Location of High School (city and state):
GED Certificate Number:
GED Issued By:
College
Major Area(s) of Study
Type of Degree
College
Major Area(s) of Study
Type of Degree
List professional, trade, business or civic activities and offices held. (Please exclude groups which indicate race, color, gender, religion, national origin, or disability).
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Please list your past work experience beginning with your most recent employment. Military experience and volunteer work may also be included as employment.
NOTE: In order to be considered for employment, you must fill in the information below, accurately and completely. You may submit a resume in addition to completing this section. Exclude any groups, which indicate race, color, religion, gender, national origin, or disability.
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for Leaving
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for Leaving
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Reason for Leaving
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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 and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*

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