Employment Application

Position applied for(*)

Invalid Input

Last Name(*)

Invalid Input

First Name(*)

Invalid Input

Middle Name

Invalid Input

Address Line 1(*)

Invalid Input

Address Line 2

Invalid Input

City(*)

Invalid Input

State(*)

Invalid Input

Zip Code(*)

Invalid Input

Home Phone

Invalid Input

Mobile Phone(*)

Invalid Input

Email Address(*)

Invalid Input

Date available for employment(*)

Invalid Input

Are you at least 18yrs of age?(*)

Yes

No

Invalid Input

Would you accept shift or night work?(*)

Yes

No

Invalid Input

Do you have any relatives working for the city of Jackson?(*)

Yes

No

Invalid Input

If yes, who?

Invalid Input

Have you ever been or are you now employed with the city of Jackson?(*)

Yes

No

Invalid Input

If yes, list department and dates employed

Invalid Input

EDUCATION

HIGH SCHOOL

Did you graduate from high school?(*)

Yes

No

Invalid Input

If not, do you have a GED

Yes

No

Invalid Input

High School Name(*)

Invalid Input

High School City(*)

Invalid Input

High School State(*)

Invalid Input

Check highest grade completed(*)

9

10

11

12

Invalid Input

Specialty Courses

Invalid Input

College

Name and location of school

Invalid Input

Major courses of study

Invalid Input

Semesters/ Hours Completed

Invalid Input

Years completed

Invalid Input

Type of degree

Invalid Input

Name and location of school

Invalid Input

Courses of study

Invalid Input

Semesters/hours completed

Invalid Input

Years completed

Invalid Input

Type of degree

Invalid Input

Name and location of school

Invalid Input

Courses of study

Invalid Input

Semesters/hours completed

Invalid Input

Years completed

Invalid Input

Type of degree

Invalid Input

MILITARY SERVICE

Branch of service:

Invalid Input

Dates of service:

Invalid Input

Type of discharge:

Invalid Input

Branch of service:

Invalid Input

Dates served:

Invalid Input

Type of discharge:

Invalid Input

EMPLOYMENT HISTORY

JOB DETAILS

Start Date (Mo/Yr)(*)

Invalid Input

End Date (Mo/Yr)(*)

Invalid Input

Company(*)

Invalid Input

Company phone

Invalid Input

Starting salary

Invalid Input

Ending salary:

Invalid Input

Job title:(*)

Invalid Input

Company address:(*)

Invalid Input

Supervisor's name:(*)

Invalid Input

Duties and responsibilities:(*)

Invalid Input

Reason for leaving:(*)

Invalid Input

May we contact this employer?(*)

Yes

No

Invalid Input

JOB DETAILS

Start date (Mo/Yr):

Invalid Input

End date (Mo/Yr)

Invalid Input

Company name:

Invalid Input

Company phone:

Invalid Input

Starting salary:

Invalid Input

Ending salary:

Invalid Input

Job title:

Invalid Input

Company address:

Invalid Input

Supervisor's name:

Invalid Input

Duties and responsibilities:

Invalid Input

Reason for leaving:

Invalid Input

May we contact this employer?

Yes

No

Invalid Input

JOB DETAILS

Start date (Mo/Yr):

Invalid Input

End date (Mo/Yr):

Invalid Input

Company name:

Invalid Input

Company phone:

Invalid Input

Starting salary:

Invalid Input

Ending salary:

Invalid Input

Job title:

Invalid Input

Company address:

Invalid Input

Supervisor's name:

Invalid Input

Duties and responsibilities:

Invalid Input

Reason for leaving:

Invalid Input

May we contact this employer?

Yes

No

Invalid Input

JOB DETAILS

Start date (Mo/Yr):

Invalid Input

End date (Mo/Yr)

Invalid Input

Company name:

Invalid Input

Company phone:

Invalid Input

Starting salary:

Invalid Input

Ending salary:

Invalid Input

Job title:

Invalid Input

Company address:

Invalid Input

Supervisor's name:

Invalid Input

Duties and responsibilities:

Invalid Input

Reason for leaving:

Invalid Input

May we contact this employer?

Yes

No

Invalid Input

DRIVING HISTORY

Do you have a valid driver's license?(*)

Yes

No

Invalid Input

Which state?

Invalid Input

Driver's license #:

Invalid Input

Expiration date:

Invalid Input

Do you have a commercial driver's license?(*)

Yes

No

Invalid Input

Which state?

Invalid Input

Which type?

Invalid Input

Driver's license #:

Invalid Input

Expiration date:

Invalid Input

PUBLIC SAFETY

Please answer the following when applying for a Public Safety position:

Police Officer, Jailer

Are you 21 years or older?

Yes

No

Invalid Input

Firefighter

Are you at least 18 years or older?

Yes

No

Invalid Input

PRE-EMPLOYMENT DRUG TESTING ACKNOWLEDGEMENT

Please complete this section only if applying for a safety sensitive position.

I hereby acknowledge and understand that, as part of my application for employment for a position which involves the performance of safety-sensitive functions as defined by 49 CFR Part 655, as amended, I must submit to a urine drug test under the authority of the U.S. Department of Transportation, Federal Transit Administration. I acknowledge and understand that any offer of employment is contingent on the passing of the aforementioned drug test and I will not be assigned to perform a safety-sensitive function unless my urine drug test has a verified negative result having no evidence of prohibited drug use.

Print name:

Invalid Input

Date:

Invalid Input

GENERAL INFORMATION

If you have special accommodations to perform the duties listed in the job description please explain:

Invalid Input

Can you submit legal verification for your right to work in the United States?

Yes

No

Invalid Input

Have you ever been convicted of or pleaded guilty or nolo to a felony or misdemeanor in the last eight years, other than a minor traffic violation?

Yes

No

Invalid Input

If yes, when?

Invalid Input

For what?

Invalid Input

Please type the security letters below(*)

Please type the security letters below

Invalid Input

Submit Application

Contact Us

Email

Phone

Address

Employment Application

EDUCATION

HIGH SCHOOL

College

MILITARY SERVICE

EMPLOYMENT HISTORY

JOB DETAILS

JOB DETAILS

JOB DETAILS

JOB DETAILS

DRIVING HISTORY

SKILLS & TRAINING

PUBLIC SAFETY

PRE-EMPLOYMENT DRUG TESTING ACKNOWLEDGEMENT

GENERAL INFORMATION

WE ARE JACKSON