General Employment Application

2. General Information

4. First Name*

5. Middle Name

6. Last Name*

8. Address*

10. City*

11. State*

12. Zip Code*

13. Country*

15. Phone Number*

17. Email Address*

19. Time
    Time

21. Are you legally authorized to work in the U.S.?*

    1. Yes
    2. No

23. Are you under the age of 18? *

    1. Yes
    2. No

24. If under the age of 18 , please state your age. (This is to address any child labor laws)

26. Have you ever been convicted of a felony?*

    1. Yes
    2. No

28. Do you now, or will you in the future, require immigration sponsorship for work authorization (eg H-1B)?*

    1. Yes
    2. No

30. How were you refered to the City of Cabot?

32. Position applying for?

34. Start Date
    Start Date

38. High School or G.E.D equivalent: School Name & Location

39. High School or G.E.D equivalent: Highest Grade Completed

41. High School or G.E.D equivalent: Grade Point Average (GPA)

42. High School or G.E.D equivalent: Course of Study (Major)

46. College or University: School Name & Location

47. College or University: Highest Grade Completed

49. College or University: Grade Point Average (GPA)

50. College or University: Course of Study (Major)

54. Vocational or Trade School: School Name & Location

55. Vocational or Trade School: Highest Grade Completed

57. Vocational or Trade School: Grade Point Average (GPA)

58. Vocational or Trade School: Course of Study (Major)

62. Graduate School: School Name & Location

63. Graduate School: Highest Grade Completed

65. Graduate School: Grade Point Average (GPA)

66. Graduate School: Course of Study (Major)

70. Education Information

72. Other (including Military): School Name & Location

73. Other (including Military): Highest Grade Completed

75. Other (including Military): Grade Point Average (GPA)

76. Other (including Military): Course of Study (Major)

80. Certifications: School Name & Location

81. Certifications: Highest Grade Completed

83. Certifications: Grade Point Average (GPA)

84. Certifications: Course of Study (Major)

88. Upload Resume

92. Background Information

94. During the past seven (7) years, have you ever been discharged, suspended or asked to resign from any position?*

    1. Yes
    2. No

96. If yes, please briefly explain:

98. For the purpose of verifying information, have you ever worked or attended school under a different name? *

    1. Yes
    2. No

100. If yes, please specify name:

104. Professional References
     List 2 professional references (that we may contact)

     List 2 professional references (that we may contact)

106. Name

107. Phone Number

109. Email Address

110. Type of Acquantance

112. Name

113. Phone Number

115. Email Address

116. Type of Acquantance

120. Work History
     List all employment experience for the past seven (7) years, starting with the most recent or present employer. (You may include, as part of your work history, any verified work performed on a volunteer basis. Resumes may not be substituted in lieu of completing the following employment information)

     List all employment experience for the past seven (7) years, starting with the most recent or present employer. (You may include, as part of your work history, any verified work performed on a volunteer basis. Resumes may not be substituted in lieu of completing the following employment information)

122. Employer 1

124. Employer Name

125. Geographic Location

127. Your Position

129. Primary Responsibilities

131. Phone Number

132. May we contact?

     1. Yes
     2. No

134. Reason for Leaving

136. Start Date
     Start Date

137. End Date
     End Date

139. Employer 2

141. Employer Name

142. Geographic Location

144. Your Position

146. Primary Responsibilities

148. Phone Number

149. May we contact?

     1. Yes
     2. No

151. Reason for Leaving

153. Start Date
     Start Date

154. End Date
     End Date

156. Employer 3

158. Employer Name

159. Geographic Location

161. Your Position

163. Primary Responsibilities

165. Phone Number

166. May we contact?

     1. Yes
     2. No

168. Reason for Leaving

170. Start Date
     Start Date

171. End Date
     End Date

173. Employer 4

175. Employer Name

176. Geographic Location

178. Your Position

180. Primary Responsibilities

182. Phone Number

183. May we contact?

     1. Yes
     2. No

185. Reason for Leaving

187. Start Date
     Start Date

188. End Date
     End Date

192. Disclosure Terms & Agreements
     (Please read the following statements fully and Initial after each)

     (Please read the following statements fully and Initial after each)

194. I have disclosed all information that is relevant and should be considered applicable to my candidacy for employment.

196. I understand, where permissible under applicable state and local law, i may be subject to pre-employment medical examinations after receiving a conditional offer of employment and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work for the City of Cabot.

198. I understand, where permissible under applicable state and local law, I may be subject to pre-employment drug testing after receiving a conditional offer of employment and must receive a negative result for illegal drugs before being permitted to commence work with the City of Cabot.

200. I understand that employment with the City of Cabot is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.

202. I expressly understand and agree that, if employed, my employment, having no specified term, is based upon mutual consent and may be terminated at will, with or without cause, by either party (City of Cabot or me) without prior notice to the other, unless otherwise prohibited by law.

204. I understand that no representation, whether oral or written, by any representative or agent of the City of Cabot, at any time, can constitute an implied or expressed contract of employment. I further understand no representative or agent of the City of Cabot has the authority to enter into and agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other terms or condition of employment other than in a document signed by the Director of Human Resources or an authorized representative.

206. I certify, under penalty of perjury, that all of the above information is true and complete and I understand that any falsification or omission of information may result in denial of employment or, if hired, may result in termination regardless of the time lapse before discovery.

208. Note: An offer of employment is conditioned upon complying with the City of Cabot's requirements including, but not limited to, signing a consent to conduct a background investigation.

210. Email

Leave This Blank:


212. 1. Receive an email copy of this form.
213. Email address

     This field is not part of the form submission.

214. Submit

* indicates a required field