APPLICATION FOR EMPLOYMENT

CITY OF KENNER, HUMAN RESOURCES 1801 WILLIAMS BLVD., KENNER, LA 70062
Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status
Last name First Middle
Date of Entry
Street Address
Home Phone
()
City, State, Zip
, , 		Business Phone
()
Have you ever applied for employment with us?
Yes No If yes: Month and Year 		Social Security No.
Position Desired
Gymnastics Instructor(REC5-17)
 		Yearly Pay Expected
Apart from absence for religious observances, are you available for full-time work?
Yes No If not, what hours can you work? - 		Will you work overtime if asked?
Yes No
Are you legally employable in the United States?
Yes No		 When will you be available to begin work?
(MM-DD-YYYY)
Other special training or skills (language, machine operation, etc.)
How did you learn of our organization?
Are you eighteen (18) years of age or older?
Yes No

DO YOU HAVE A DRIVER'S LICENSE? Yes No CLASS OF LICENSE
SCHOOL
NAME AND LOCATION OF SCHOOL
COURSE OF STUDY
NO. OF
YEARS
COM-
PLETED
DID YOU
GRADUATE?
DEGREE
OR DIPLOMA
College
Yes
No
High
Yes
No
Elementary
Yes
No
Other
Yes
No
MEMBERSHIP IN PROFESSIONAL OR CIVIC ORGANIZATIONS
(Exclude those which may disclose your race, color, religion or national origin)
COMPLETE THIS SECTION IF YOU SERVED IN THE U.S. ARMED FORCES Branch of Service
Describe your duties and any special training
Period of Active Duty (Month and Year)
From (MM-YYYY) To (MM-YYYY)
Rank at Discharge
Date of Final Discharge

EMPLOYMENT

Please give accurate, complete full-time and part-time employment record. Start with present or most recent employer
1
Company Name
Address
Name of Supervisor
State Job Title and Describe your Work
Telephone
Employed (State Month and year)
(MM-YYYY)
(MM-YYYY)
Weekly Pay
Start
Last
Reason for leaving
2
Company Name
Address
Name of Supervisor
State Job Title and Describe your Work
Telephone
Employed (State Month and year)
(MM-YYYY)
(MM-YYYY)
Weekly Pay
Start
Last
Reason for leaving
3
Company Name
Address
Name of Supervisor
State Job Title and Describe your Work
Telephone
Employed (State Month and Year)
(MM-YYYY)
(MM-YYYY)
Weekly Pay
Start
Last
Reason for leaving
We may contact the employers listed above unless
you indicate those you do not want us to contact.
DO NOT CONTACT
Employer Number(s) Reason
Have you ever been bonded?
Yes No If Yes, with what employers?
Have you ever been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled,
expunged or sealed by a court? Yes No If Yes, describe in full
State names of relatives and friends working for us other than your spouse.
The information provided in this Application for Employment is true, correct and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal.
I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.
If you decide to engage an investigative consumer reporting agency to report on my cr and personal history I authorize you to do so. If a report is obtained, you must provide, at my request, the name of the agency so I may obtain from them the nature and substance of the information contained in the report.