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Applicant Information

APPLICATION FOR CITY EMPLOYMENT
Date of Application:*
Date of Application:
Position Desired (Anything other than an open position will not be accepted):*
First Name*
Last Name*
Address:*
City*
State*
Zip*
Home Phone:*
Cell Phone:
E-Mail:
Work availabilty:*
1. Full Time
2. Part Time
1. Shifts
1. Weekends
1. Nights
Date available for work:*
Date available for work:
If Part Time, list hours and days available:
Have you ever worked for this City?:*
1. Yes
2. No
If yes, give prior names, dates, and reason(s) for leaving:
Are you related to any City employee or any member of the City Commission?:*
1. Yes
1. No
If yes, give name, department and relationship:
Are you legally eligible to work in the United States? *
(Verification will be based upon employment and failure to furnish documentation will be cause for separation.)
1. Yes
1. No
Do you hold a current and valid driver’s license?*
1. Yes
1. No
If Yes, provide:
State:
Expiration Date:
DL#:
If CDL, what class?
Have you been convicted of a felony in the last seven years?: *
1. Yes
2. No
Are you currently charged with the commission of a felony?:*
1. Yes
2. No
If yes, state what, when and where:
Note: This information does not, in itself, disqualify you from employment.
How did you hear about this position?
1. Newspaper
2. City Website
3. City Hall
1. Social Media
2. Word of Mouth
3. Other (Please Specify)
If other, please specify:
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Military Service

Are you currently or have you previously been in the US Military?
1. Yes
2. No
If yes, what branch?
Date Entered:
Date Entered:
Date Discharged:
Date Discharged:
Type of Discharge?
Indicate specific military experience or training that is job related:
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References

Give name, address and phone number of three references who are not related to you and are not previous employers:
Reference #1
First Name:*
Last Name:*
Address:
Phone Number:*
City:*
State:*
Zip:*
Reference #2
First Name:*
Last Name:*
Address:
Phone Number:*
City:*
State*
Zip*
Reference #3
First Name:*
Last Name:*
Address:
Phone Number:*
City:*
State:*
Zip:*
After reviewing the essential job functions from the job description, are you able to perform them?*
1. Yes
2. No
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Educational Records

High School or Institution Name:*
Address:
Did you graduate?*
1. Yes
2. No
3. GED
If no, list number if years completed:
GED School Name:
Address:
College Name:
Address:
Did you graduate?
1. Yes
2. No
If no, list number of years completed:
Course of Study:
List diploma or degree:
Other educational background (please specify):
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Employment History

May we contact your current employer?*
1. Yes
2. No
Reference #1:
Employer Name:
Phone Number:
Address:
City:
State:
Zip:
Dates of employment:
Dates of employment: Start Date
—
Dates of employment: End Date
Work performed:
Job Title:
Supervisor:
Reason for leaving:
Reference #2:
Employer Name:
Phone Number:
Address:
City:
State:
Zip:
Dates of employment:
Dates of employment: Start Date
—
Dates of employment: End Date
Work Performed:
Job Title:
Supervisor:
Reason for leaving:
Reference #3:
Employer Name:
Phone Number:
Address:
City:
State:
Zip:
Dates of employment:
Dates of employment: Start Date
—
Dates of employment: End Date
Work Performed:
Job Title:
Supervisor:
Reason for leaving:
Reference #4:
Employer Name:
Phone Number:
Address:
City:
State:
Zip:
Dates of employment:
Dates of employment: Start Date
—
Dates of employment: End Date
Work Performed:
Job Title:
Supervisor:
Reason for leaving:
Please list any additional skills not listed above.
Attachment
Attachment 2
Attachment 3
Attachment 4
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Job Functions

After reviewing the essential job functions from the job description, are you able to perform them?
1. Yes
1. No
In addition, review the minimum qualifications and provide us with prior education, work experience, and any relevant training or certificates and licenses that would indicate your knowledge, skills, and abilities to perform the job.
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Signature

It is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and /or separation from the employer’s service if I have been employed. As an applicant for a position with the City of Woodward, I have been asked to furnish information for use in reviewing my background and qualifications. In this connection, I hereby authorize the City of Woodward to investigate my past and present work, character, education, military and police records to ascertain any and all information which may be pertinent to my employment qualifications. I agree to cooperate in such investigation and release from all liability or responsibility all persons and corporations requesting or supplying such information. I understand that the City of Woodward has a mandatory drug screen program for job applicants who are offered employment. If I am offered employment by a City department, I understand I will be required to provide a urinalysis sample and/or blood test for drug screen purposes. The screen will be to identify the presence of controlled or other prohibited substances. Failure of the drug screen or refusal to submit to the screen will result in denial of employment. I understand that, if the position requires it, I must possess and maintain a valid Oklahoma driver’s license during the course of my employment and I must meet the requirements of the City’s insurance carrier. The City of Woodward is an Equal Opportunity Employer. The City of Woodward does not discriminate in employment and no questions on this application are used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law. This application is current for only the job specified. If I have not heard from the City of Woodward and still wish to be considered for employment for another job opening, it will be necessary to fill out a new application. I understand that, just as I am free to resign at any time, my employment and compensation is terminable at-will. The City of Woodward may terminate my employment at any time and for any reason whatsoever, with or without good cause and without prior notice. I understand that no representatives of the City of Woodward have the authority to make any assurances to the contrary. I hereby acknowledge that I have read the above statements and understand the same.
Print Name:*
Electronic Signature Agreement. By selecting the "Submit" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "Submit" you consent to be legally bound by this Agreement's terms and conditions.
Signature:*
Date:*
Date:
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Dear Applicant

PLEASE KEEP THIS PAGE FOR YOUR INFORMATION
Dear Applicant:
The City of Woodward wishes to thank you for your interest in employment with us.
If your application is chosen for further consideration, you will be contacted to schedule an interview. After the interviewing process, which may include more than one interview, as well as testing, a selection will be made. If chosen, you will then be advised to report to the Human Resources department to begin the hiring process. The hiring process is not complete until all steps are followed and approved by the City Manager.
We thank you for your time and interest in becoming part of the City of Woodward workforce. Current job listings are available at:
Office Location: City Hall 722 Main Street Woodward, OK 73801 City Website: www.cityofwoodward-ok.gov
Human Resources: mparks@cityofwoodward-ok.gov (580) 254-8590 Office (580) 254-8514 Fax
This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint filing cust.html , or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. For TTD or TTY options, please dial 711.

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