Application for Employment

McPherson Area Solid Waste Utility

1431 17^th Ave.

McPherson, KS 67460

620-241-6559

PLEASE PRINT

Position(s) applied for ___________________________________________Date of application ______________

Name _______________________________________________________Social Security #_________________

LAST FIRST MIDDLE

Address____________________________________________________________________________________

STREET CITY STATE/ ZIP CODE

Telephone # (_____)__________ Mobile/Beeper/Other #(____)____________ Email Address _______________

___________

If you are under 18, and it is required, can you furnish a work permit?.........................................................YesNo

Have you ever been employed here before? If yes, give dates and positions………………………………..YesNo

Are you legally eligible for employment in this country?................................................................................YesNo

Date available for work _____/____/_____ What is your desired salary range?________________ $______

Types of employment desired Full-Time Part- Time Temporary Seasonal

Are you able to meet the attendance requirements of the position?.............................................................YesNo

Have you ever pled “guilty” or “no contest” to, or been convicted of a crime? ………………………………..YesNo

ANSWERING “YES TO THESE QUESTIONS DOES NOT CONSTITUE AN AUTOMATIC BAR TO EMPLOYEMENT. FACTORS SUCH AS DATE OF OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION,REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT.

Driver’s license number if driving is an essential job function __________________________________State________

Provide the following information of your past four (4) years of employers, assignments or volunteer activities, starting with the most recent.

From	To		Employer			Telephone #
						( )
STARTING JOB TITLE /FINAL JOB TITLE			ADDRESS
IMMEDIATE SUPERVISOR AND TITLE			SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
MAY WE CONTACT FOR REFERENCE?
Yes No Later
REASON FOR LEAVING			HOURLY RATE/SALARY
			Start $__________ per_____ Final $_________ per_____
From	To		Employer			Telephone #
						( )
STARTING JOB TITLE /FINAL JOB TITLE			ADDRESS
IMMEDIATE SUPERVISOR AND TITLE			SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
MAY WE CONTACT FOR REFERENCE?
Yes No Later
REASON FOR LEAVING			HOURLY RATE/SALARY
			Start $__________ per_____ Final $_________ per_____
From	To		Employer			Telephone #
						( )
STARTING JOB TITLE /FINAL JOB TITLE			ADDRESS
IMMEDIATE SUPERVISOR AND TITLE			SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
MAY WE CONTACT FOR REFERENCE?
Yes No Later
REASON FOR LEAVING			HOURLY RATE/SALARY
			Start $__________ per_____ Final $_________ per_____
From	To		Employer			Telephone #
						( )
STARTING JOB TITLE /FINAL JOB TITLE			ADDRESS
IMMEDIATE SUPERVISOR AND TITLE			SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
MAY WE CONTACT FOR REFERENCE?
Yes No Later
REASON FOR LEAVING			HOURLY RATE/SALARY
			Start $__________ per_____ Final $_________ per_____
Skills and Qualifications
Summarize any training, skills, licenses and/ or certificates that may qualify you as being able to perform
job-related functions in the position for which you are applying. ____________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Educational Background (if job related)
Name and Location		Number of year complete			Did you Graduate?			Course of Study
HIGH SCHOOL
COLLEGE							MAJOR
							DEGREE
OTHER
References
NAME				TELEPHONE					# OF
									YEARS KNOWN
				( )
				( )
				( )

I certify that all information I have provided in order to apply for and secure work with the employer is true, compete, and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representative for seeking, gathering and using such information in the employment process and all other person, corporations or organizations for furnishing such information about me.

I understand that this application remains current for only 30 days. At the conclusion of time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete and I-9 Form in this regard.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant _____________________________________________Date___________