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2. 
4. Date
   Date
5. Position applied for:*
7. Applicant Data
9. How were you referred to us:
11. Name*
12. Email Address
14. Address*
16. City
17. State
18. Zip Code
20. Primary Phone Number*
21. Cell Phone/Other Phone
23. Date available to start*
24. Salary Requirements
26. If you are under 18 and we require a work permit, can you furnish one?

    1. Yes
    2. No
28. If no, please explain
30. Have you ever worked for the City of Tuttle?*

    1. Yes
    2. No
31. If yes, when?
33. Do you have a relative who works for the City of Tuttle or is on the City Council?*

    1. Yes
    2. No
34. If yes, who?
36. Are you a citizen of the United States?*

    1. Yes
    2. No
37. If not, do you have work papers?
39. Type of employment desired*

    1. Full-time
    2. Part-time
    3. Temporary
    4. Seasonal
41. Have you ever pled "guilty" or "no contest" to or been convicted of a crime?*

    1. Yes
    2. No
43. If yes, give details
45. Education
47. High School:
48. City & State:
50. No. Years Completed
51. Did you graduate?
53. College/University
54. City & State
56. Years Completed
57. Did you graduate?
58. Degree
59. Major
61. Please list other degrees, training, and apprenticeships
63. References
65. Name*
66. Phone
68. Address
70. City
71. State
72. Zip Code
76. Name*
77. Phone
79. Address
81. City
82. State
83. Zip Code
85. Emergency Contact
87. First Name*
88. Last Name*
90. Address
91. Relationship to you
93. Phone*
95. Previous Employment (begin with most recent)
99. Position(s) Held
100. Date of Employment
101. From - To
     From - To Start Date

     —

     From - To End Date
103. Firm*
104. Address
106. Phone
107. Supervisor
108. Title
110. Responsibilities
112. Starting Salary
113. Title
114. Current/Ending Salary
115. Title
117. Reason for Leaving
119. May we contact this employer for reference?

     1. Yes
     2. No
123. Position(s) Held
124. Date of Employment
125. From - To
     From - To Start Date

     —

     From - To End Date
127. Firm*
128. Address
130. Phone
131. Supervisor
132. Title
134. Responsibilities
136. Starting Salary
137. Title
138. Current/Ending Salary
139. Title
141. Reason for Leaving
143. May we contact this employer for reference?

     1. Yes
     2. No
147. Position(s) Held
148. Date of Employment
149. From - To
     From - To Start Date

     —

     From - To End Date
151. Firm*
152. Address
154. Phone
155. Supervisor
156. Title
158. Responsibilites
160. Starting Salary
161. Title
162. Current/Ending Salary
163. Title
165. Reason for Leaving
167. May we contact this employer for reference?*

     1. Yes
     2. No
169. Signature
171. I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigation and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application.
173. In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.
175. Signature of Applicant*
176. Date*
     Date
Leave This Blank:


178. 1. Receive an email copy of this form.
179. Email address

     This field is not part of the form submission.

180. Submit Submit and Print

* indicates a required field