Position Applied for * Select One Accountant Administrative Animal Control Officer Clerical Custodial Engineering Information Technology Inspector/Electrical Inspector/Housing Inspector/Plumbing Laborer/Driver (with CDL) Maintenance Worker Manager/Supervisor Mechanic Parking Enforcement Police Department School Crossing Guard Summer/Seasonal Transit Driver Waste Water Treatment Technician Water Filter Technician    Date
Referral Source * Select One Advertisement Employee Relative Government Employment Agency Walk In Private Employment Agency Other Name of Source (If Applicable)

Last Name * First Name * Middle
Street * 
City *  State * Select one AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY       Zip Code *   
Phone (no dashes) *  If necessary, the best time to call you at home is *
Cell Phone (no dashes)    Fax Number   Social Security Number (OPTIONAL)
May we contact you at work  * Select one Yes No   If yes, work number (no dashes) and best time to call 
Have you filed an application here before  * Select one Yes No    If yes, give date (mm/dd/yyyy)
Have you ever been employed here before * Select one Yes No    If yes, give dates (mm/dd/yyyy) FROM  TO
Are you a Vietnam Era Veteran?   * Select one Yes No
Are you legally eligible for employment in this country?     * Select one Yes No
(Proof of U.S. citizenship or immigration status will be required upon employment.)
When can you start work?   *
Type of employment desired?   * Select One Full Time Part Time Temporary Seasonal Educational Co-Op
Are you on a lay-off and subject to recall?     * Select one Yes No
Will you work nights if required?    * Select one Yes No
Will you work overtime if required?      * Select one Yes No
Do you understand that you may be required to undergo a pre-employment physical?   * Select one Yes No
Have you ever been bonded?      * Select one Yes No
Driver's license number, if required by job (no dashes)    Class    State Select one AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY
CDL?  * Select one Yes No
Hazmat Endorsement?  * Select one Yes No

EMPLOYMENT HISTORY

List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any
gaps in employment in  comments section below.

Employer Telephone (no dashes) Address
Job Title Immediate Supervisor and Title
Reason for leaving
Dates Employed (mm/dd/yyyy) From  To
Starting Hourly Rate/Salary  $ PER    Final Hourly Rate/Salary  $ PER
Summarize the nature of the work performed and job responsibilities
May we contact for Reference?   Select one Yes No Later

Employer Telephone (no dashes) Address
Job Title Immediate Supervisor and Title
Reason for leaving
Dates Employed (mm/dd/yyyy) From  To
Starting Hourly Rate/Salary  $ PER    Final Hourly Rate/Salary  $ PER
Summarize the nature of the work performed and job responsibilities
May we contact for Reference?   Select one Yes No Later

Employer Telephone (no dashes) Address
Job Title Immediate Supervisor and Title
Reason for leaving
Dates Employed (mm/dd/yyyy) From  To
Starting Hourly Rate/Salary  $ PER    Final Hourly Rate/Salary  $ PER
Summarize the nature of the work performed and job responsibilities
May we contact for Reference?   Select one Yes No Later

Employer Telephone (no dashes) Address
Job Title Immediate Supervisor and Title
Reason for leaving
Dates Employed (mm/dd/yyyy) From  To
Starting Hourly Rate/Salary  $ PER    Final Hourly Rate/Salary  $ PER
Summarize the nature of the work performed and job responsibilities
May we contact for Reference?   Select one Yes No Later

Comments (including explanation of any gaps in employment)

SKILLS AND QUALIFICATIONS

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our Company.

EDUCATIONAL BACKGROUND

HIGH SCHOOL
          School Name Address
          Dates Attended (mm/dd/yyyy)  FROM TO     Degree or Diploma
COLLEGE
          School Name Address
          Dates Attended  (mm/dd/yyyy)  FROM TO     Degree or Diploma
OTHER
         School Name Address
          Dates Attended  (mm/dd/yyyy)  FROM TO     Degree or Diploma
OTHER
         School Name Address
          Dates Attended  (mm/dd/yyyy)  FROM TO     Degree or Diploma

REFERENCES

List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not
applicable, list three school or personal references who are not related to you.
Name *        Telephone (no dashes) *           Years Known *
Name *        Telephone (no dashes) *           Years Known *
Name *        Telephone (no dashes) *           Years Known *

List professional, trade, business or civic associations and any officers held. (Exclude memberships which would reveal sex, race, religion,
 national origin, age ancestry or other protected status.)
Organization
      Offices Held
Organization
      Offices Held
Organization
      Offices Held

List special accomplishments, publications, awards. (Exclude information which would reveal sex, race, religion, national origin, age, ancestry,
 handicap or other protected status.)

List any additional information you would like us to consider.

It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application
 and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign at any time,
 the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that
 no representative of the Employer, no matter what his or her title or grade, has the authority to make any assurances to the contrary.

I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from
 liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for
furnishing such information.

The Employer is an equal opportunity employer. The employer does not discriminate in employment and no question on this application is
used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state or
federal law.

This application is current for only (12) months. At the conclusion of this time, if I have not heard from the Employer and still wish to be
considered for employment, it will be necessary for me to fill out a new application.

I understand that employment with the City of Quincy will be contingent on my submitting to a physical examination and drug testing
and satisfying the physical qualifications for employment as determined by the City as being necessary for performance of a particular job.
I understand that if I am employed, I must live in the City of Quincy or one of its townships. The townships are Quincy, Melrose, Ellington
 and Riverside.

Please "sign" this application by typing in your legal name. By doing so, you attest that you are who you say you are, that all the information
 is correct, and that you agree to the terms above.

Signed  *

Please enter your email address below (optional):