Application for Employment

Last Name*

First Name*

Middle Name

Street Address*

City*

State*

Zip

Primary Ph#:*

Secondary Ph#:

E-Mail:

Driver’s License#:

Classification:

Departments:

Check All That Apply

Work Preference:* Full Time Part Time Seasonal Volunteer

Referral Source: Walk-in Employee Relative Advertisement

Name of Source (if applicable):

Date available for work....*

Desired Salary range?:

Have you submitted an application to the Park District before? Yes No

If yes, give date(s) and position(s)...

Have you ever been employed by Fon du Lac Park District?...* Yes No

If yes, give date(s) and position(s)...

If you are under 16 and it is required, can you furnish a work permit?... Yes No

If no, please explain...

The best time to call you is...

Have you ever been in the US Military Service?... Yes No

If yes, date entered:

Date discharged:

Rank/Grade at time of discharge:

Employment History

Starting with your most recent employer, assignments or volunteer activities, provide the following information.

From (Month/Year)

To (Month/Year)

Employer

Telephone #

Starting job title / final job title

Streeet Address

City

State

Immediate supervisor and title

May we contact for reference? Yes No Later

Summarize the nature of work performed and job responsibilities

Reason for leaving

Educational Background

School (Include City and State)	Number of Years Completed	Level of Completion	Course of Study
		GED Diploma Degree
		GED Diploma Degree
		GED Diploma Degree

References (Non-Relatives)

Name	Title	Relationship To Candidate	Telephone	Number of Years Known

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.

It is the policy of the Fon du Lac Park District to provide equal opportunities to all qualified employees and applicants for employment without regard to race, color, religion, sex age, national origin, ancestry, or physical or mental handicap.

I hereby certify that all statements made on or in connection with this application, including those regarding my training and experience are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for its cause for dismissal.

Upload Resume (Max Uploading size: 2MB)

Electronic Signature of Applicant:*

Date: