Form Center

2. General Application Form
4. City of Sioux Center
6. 335 1st Avenue NW, Sioux Center IA 51250

8. ---
10. Applicant Information:
12. Name:*
13. SSN:*
15. Home Address:*
17. College Address:
19. Phone Number(s):*
21. Date of Birth:
22. E-mail Address:*
24. Date Available:*
25. Desired Salary: $
27. Positioned Applied For:*
29. Are you eligible to work in the United States?*

    1. Yes
    2. No
31. Have you ever worked for this organization?*

    1. Yes
    2. No
33. Employment desired?*

    1. Full Time
    2. Part Time
35. Hours of work (per week) desired?*
37. Have you ever been convicted of a felony?*

    1. Yes
    2. No
39. If yes, explain:
41. (Number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, and sentence(s) imposed)
43. 
    
45. Education:
47. High School:*
48. Address:
50. Did you graduate?*

    1. Yes
    2. No
51. Degree:
53. College:
54. Address:
56. Did you graduate?

    1. Yes
    2. No
57. Degree:
59. Other:
60. Address:
62. Did you graduate?

    1. Yes
    2. No
63. Degree
65. 
    
67. Previous Employment:
69. Company:
70. Phone:
72. Address:
74. Job Title:
75. Supervisor:
77. Starting Salary: $
78. Ending Salary: $
80. Responsibilities:
82. From / To:
84. Reason for Leaving:
86. May we contact your previous supervisor for a reference?

    1. Yes
    2. No

88. ---
90. Company:
91. Phone:
93. Address:
95. Job Title:
96. Supervisor:
98. Starting Salary: $
99. Ending Salary: $
101. Responsibilities:
103. From / To:
105. Reason for Leaving:
107. May we contact your previous supervisor for a reference?

     1. Yes
     2. No
109. 
     
111. References:
113. Please include Name, City, & Phone Number
115. Reference 1:*
117. Relationship:
119. Reference 2:*
121. Relationship:

123. ---
125. I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.
127. 
     
129. I understand that the company may require me to successfully complete a pre-employment drug and alcohol test as a condition of employment and that continued employment may be based on the successful completion of similar tests.
131. 
     
133. I understand that the company may as part of the hiring process request an investigative consumer report from a third party entity or agency including information concerning my character, general reputation, personal characteristics, credit records, and mode of living. I may make a written request to the company o provide me with additional information regarding the nature and scope of any such report.
135. 
     
137. I understand that employment with your company is "at will" and nothing in the interview or hiring process, this application, or your company policies are intended to create an employment contract between myself and the company. Employment may be terminated by either party at any time for any reason or without notice.
139. 
     
141. In addition to completion of this form, the Lifeguard or Arena Application Form (whichever you are seeking employment for) also needs to be completed.
143. 
     
145. Name:*
146. Date:*
Leave This Blank:


148. 1. Receive an email copy of this form.
149. Email address

     This field is not part of the form submission.

150. Submit Submit and Print

* indicates a required field