Employment Application

Position Applying For (required)

Contact Information

Full Name (required)

Address, City, State (required)

Email (required)

Phone (required)

Do you have any relatives currently employed by PVRPD? (required)

Yes

Name of Relative if Applicable

Education

High School Graduate/GED Certificate (required)

Yes

If No, Highest Level Completed

College, Business or Trade Schools Attended

Major

Credits Completed

Degree

AA/AAS/AS

BA/BS/BAS/BBA

MBA/M.Ed/MPA/MS

Other

List all periods of employment for the last ten years, beginning with the most recent. include volunteer, military, or other special experience if applicable (attach additional sheets as necessary).

Work Experience 1

Employer

Address, City, State

Telephone

Supervisor

Job Title

Dates of Employment

Reason for Leaving

Type of Position

Hours worked per week

Duties Assigned

May We Contact?

Yes

Why Not

Work Experience 2

Employer

Address, City, State

Telephone

Supervisor

Job Title

Dates of Employment

Reason for Leaving

Type of Position

Hours worked per week

Duties Assigned

May We Contact?

Yes

Why Not

Work Experience 3

Employer

Address, City, State

Supervisor

Job Title

Telephone

Dates of Employment

Reason for Leaving

Type of Position

Hours worked per week

Duties Assigned

May We Contact?

Yes

Why Not

References (other than those listed above)

Name, Phone, Email, Relationship

Additional Information

List any professional trainings, conferences and workshops attended related to the position.

List all professional or trade licenses, certificates or registrations.

Cover Letter

Resume

Supplemental Questionnaire

Certification of Applicant

I certify that all statements made in this application are true and complete, and that any misstatement of material facts may result in disqualification or dismissal. (required)

I AGREE

The following AUTHORIZATION AND RELEASE has been prepared to expedite background inquiries on employment applications. You are not required to sign this form in order to have your application considered. However, failure to sign may impede the ability of the District to obtain information pertinent to your qualifications for employment.

I hereby specifically authorize and direct any previous or current employers to release to the Human Resources Office of the Pleasant Valley Recreation and Park District, any and all information of whatever kind possessed by them, in either verbal or written form, as Pleasant Valley Recreation and Park District may request regarding myself, including opinions as to job performance, character, competency, honesty, ability, work injuries and safety record, and any and all records related to me personally, which may have been kept either public or private. I understand and acknowledge that this authorization will permit positive as well as negative information to be released to the Human Resources Office of the Pleasant Valley Recreation and Park District described above and the release of negative information may adversely impact my being hired by the same. I hereby release Pleasant Valley Recreation and Park District and its officers, agents, representatives, and employees and hold them harmless from any and all liability for the use of any and all of the foregoing information, in consideration for being reviewed for the aforesaid position. I further release any previous or current employers from liability or damage which may result from furnishing the information requested. I also request that a copy of this release be treated as conveying the same authority as the signed original. (required)

I AGREE

Digital Signature (required)

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