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Applicant Information Name First Middle Last Suffix address Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Phone Number Email Best time to contact you at home is Position(s) Applied For Position(s) Position(s) Position(s) Item weight Add more items more items Department Department Department Item weight Add more items more items When can you start? Employment Authorization Have you ever filed an application with the City of Kotzebue before? Yes No Have you ever been employed with the City of Kotzebue before? Yes No Do any of your friends or relatives, other than spouse, work here? Yes No Are you currently employed? Yes No Are you currently on “lay-off” status and subject to recall? Yes No Can you travel if a job requires it? Yes No Are you lawfully allowed to be employed in the United States? Yes No If you are under 18 years of age, can you provide proof of your eligibility to work? Yes No Do you have a Drivers License? Yes No Do you have a CDL License? Yes No Education Name of School (High School) Number of Years Completed? Diploma or Degree? Name of School (College) Number of Years Completed? Diploma or Degree? Other Education (Specify) Specialized Education, Trainings and Skills Specialized Education, Trainings and Skills Certifications Certifications Previous Employment (List Most Recent First) Job #1 Company Job Title Phone Number City and State City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Start Date End Date Starting Pay Ending Pay Work Performed Reason for Leaving Job #2 Company Job Title Phone Number City and State City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Start Date End Date Starting Pay Ending Pay Work Performed Reason for Leaving Job #3 Company Job Title Phone Number City and State City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Start Date End Date Starting Pay Ending Pay Work Performed Reason for Leaving References *Must have at least three references with at least one professional reference Name Phone Number Relationship Name Phone Number Relationship Name Name Name Item weight Add more items more items Phone Number Phone Number Phone Number Item weight Add more items more items Relationship Relationship Relationship Item weight Add more items more items Background Check Authorization Statement I, hereby authorize the City of Kotzebue to conduct a background check as part of the employment application process. I understand that this may include obtaining information from various sources, including but not limited to, past employers, educational institutions, and law enforcement agencies. I understand that this background check may include checks for misdemeanors and felonies. I understand that this background check may include checks for misdemeanors and felonies. Signature Date Check Box By checking the box, I agree and certify that my printed signature is my signature and I agree to conduct this transaction electronically. Birthdate Please Note: • Your signature on this authorization form indicates your consent for us to proceed with the background check process. please note 2 • Should there be any discrepancies or concerns regarding the information obtained during the background check, you will be given the opportunity to provide clarification or explanation. Applicant’s Statement I certify that the answers given herein are true and complete. Statement 2 I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. Statement 3 This application for employment shall be considered active for a period of time not to exceed one (1) year from the date of signature. Any applicant wishing to be considered for employment beyond this time period must submit a new, completed and signed application form. Statement 4 In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. Signature Date Check Box By checking the box, I agree and certify that my printed signature is my signature and I agree to conduct this transaction electronically. The City of Kotzebue is an equal opportunity employer The City of Kotzebue is an equal opportunity employer We consider applications for all positions without regard to race, color, religion, creed, sex, national origin, disability, sexual orientation, citizenship status or any other legally protected status We consider applications for all positions without regard to race, color, religion, creed, sex, national origin, disability, sexual orientation, citizenship status or any other legally protected status. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Leave this field blank Print
