2. City of Boaz, Alabama Employment Application

   Equal Opportunity Employer. Incomplete applications will not be considered. Type “N/A” in any space that does not apply to you.

   
   

   The City of Boaz only accepts applications for open available positions that are listed on the Current Employment Opportunities page. Applications will not be accepted for future employment opportunities.

4. Send resumes to:

   crystal.buchanan@cityofboaz.org

   jeff.sims@cityofboaz.org

   
   

6. Position Applied for:*
   -- Select One --LifeguardAPOST Certified Police OfficerParks & Recreation Worker (Concessions, Field Crew, Scorekeepers) - Temporary
8. Applicant Information
10. Date
12. Last Name
13. First Name
14. M.I.
16. Address
18. City
19. State
20. Zip Code
22. Phone Number
23. Email Address
25. Date Available
27. Are you a citizen of the United States?

    1. Yes
    2. No
28. If no, are you authorized to work in the U.S.?

    1. Yes
    2. No
30. Are you willing to relocate to Boaz, Alabama?

    1. Yes
    2. No
31. When would you be able to relocate?
33. Have you ever been convicted of a felony?

    1. Yes
    2. No
34. If yes, please explain.
38. Education
40. High School
41. High School Address
43. Dates Attended
44. Did you graduate?

    1. Yes
    2. No
45. Degree
47. College
48. College Address
50. Dates Attended
51. Did you graduate?

    1. Yes
    2. No
52. Degree
54. Other
55. Address
57. Dates Attended
58. Did you graduate?

    1. Yes
    2. No
59. Degree
63. References
    Please list 3 professional references.
65. First Name
66. Last Name
68. Relationship
69. Company
70. Phone
72. Address
74. City
75. State
76. Zip Code
78. First Name
79. Last Name
81. Relationship
82. Company
83. Phone
85. Address
87. City
88. State
89. Zip Code
91. First Name
92. Last Name
94. Relationship
95. Company
96. Phone
98. Address
100. City
101. State
102. Zip Code
106. Previous Employment
108. Company
109. Phone
111. Address
113. City
114. State
115. Zip Code
117. Supervisor
118. Job Title
120. Responsibilities
121. From
122. To
124. Reason for Leaving
125. May we contact your previous supervisor for a reference?

     1. Yes
     2. No
127. Company
128. Phone
130. Address
132. City
133. State
134. Zip Code
136. Supervisor
137. Job Title
139. Responsibilities
140. From
141. To
143. Reason for Leaving
144. May we contact your supervisor for a reference?

     1. Yes
     2. No
146. Company
147. Phone
149. Address
151. City
152. State
153. Zip Code
155. Supervisor
156. Job Title
158. Responsibilities
159. From
160. To
162. Reason for Leaving
163. May we contact your supervisor for a reference?

     1. Yes
     2. No
165. Are you a Veteran?

     1. Yes
     2. No
167. Disclaimer and Signature
     I represent and warrant that the information I have given on this application is full and true to the best of my knowledge. If I become an employee I understand that false, incomplete, or misleading statements on this application may be considered sufficient cause for dismissal. The use of this application does not in any way obligate the City. I understand that any offer of employment is contingent upon a satisfactory criminal background investigation. The Immigration Reform and Control Act of 1986 requires that, after employment, employers verify the legal work authorization and identity of all new employees. An offer of employment will depend upon the City's ability to verify this necessary information and a satisfactory pre-employment physical and drug screen. I give permission for my former employers and references to answer any and all questions based upon information available to them in my prior employment records. I release the City and all former employers from any liability as a result of this furnishing and receiving of this reference information. I understand that the City will attempt to verify statements made on my application and those made during my employment interview.
169. Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
171. Electronic Signature*
172. Date*
176. Equal Employment Opportunity Form
178. Name*
179. Email Address
181. Address*
183. City*
184. State*
185. Zip Code*
187. Phone Number*
188. Position Applied for*
190. Voluntary Information
     This information is being requested in accordance with federal regulations. The information is voluntary and will not be used when considering you for employment with our company.
192. Racial or Ethnic Group

     1. American Indian/Alaskan
     2. Asian/Pacific Islander
     3. Black/African American
     4. Hispanic/Latino
     5. White/Caucasian
     6. Other
193. Gender

     1. Female
     2. Male
194. Military Service

     1. Pre-Vietnam Era
     2. Vietnam Era
     3. Post-Vietnam Era
     4. Disabled Veteran
196. How did you hear about this position?
200. Electronic Signature Agreement*

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
202. Electronic Signature*
203. Date of Signature*
205. Name of Employer/Prospective Employer
Leave This Blank:


207. 1. Receive an email copy of this form.
208. Email address

     This field is not part of the form submission.

209. Submit Submit and Print

* indicates a required field