Village General Employment Application

The Village of Mukwonago is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, age, sex, religion or national origin

APPLICANT PLEASE READ THE FOLLOWING INSTRUCTIONS BEFORE ANSWERING ANY QUESTIONS

Answer all questions as completely as space will permit. Failure to complete application may prohibit you from proceeding in the evaluation process for this position.

Statements made in this application are subject to verification. The detection of false statements is a cause for disqualification or dismissal.

Date and sign the application and the bottom of this form.

A copy of this submission will be emailed to the email address provided in the application.

Position Applying For

Type of Employment

Full-Time
Part-Time

How did you find out about the position you are applying for?

Personal Information

Name

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Daytime Phone

Mobile Phone

Email

Are you legally entitled to work in the United States?

Yes
No

Are you age 18 or over?

Yes
No

If No, enter date of birth

Do you possess a valid Driver’s License?

Yes
No

Driver's License Number

Do you possess a valid Commercial Driver’s License?

Yes
No

If yes, check all that apply

Special skills and qualifications that may apply to the position (please include all computer software which you can operate skillfully)

List any memberships in professional or technical associations

Current certifications, licenses, or registrations as a member of a trade or profession

Education and Training

Name and Location of High School

Highest Grade or Year Completed

Do you have a high school diploma, GED or HSED?

Yes
No

Training Beyond High School (College or University, Business College or other schools you have attended)

Name and Location

Start Date

End Date

Minor/Major

Degree

GPA

Graduate?

Yes
No

Name and Location

Start Date

End Date

Minor/Major

Degree

GPA

Graduate?

Yes
No

Name and Location

Start Date

End Date

Minor/Major

Degree

GPA

Graduate?

Yes
No

Name and Location

Start Date

End Date

Minor/Major

Degree

GPA

Graduate?

Yes
No

Name and Location

Start Date

End Date

Minor/Major

Degree

GPA

Graduate?

Yes
No

Describe any education and training you have had which is not covered above, such as vocational school, correspondence courses, service schools, inservice training, or volunteer work which you feel is relevant to the job you are applying for

Employment History

Work experience: provide a complete description, start with your most recent job and work back. Be sure to include service in the armed forces. Explain any gaps between periods of employment. If more space is required, continue entries on separate sheet arranged as below and attach to application. Although resumes are welcome, they may not be substituted for the information requested below.

Employer Name

Type of Business

Address

Street Address Address Line 2 City State ZIP Code

Job Title

Type of Employment

Full-Time
Part-Time

Start Date

End Date

Your Duties

Supervisor

First Last

Supervisor Phone Number

Starting Salary

Ending Salary

Reason for Leaving

May we contact this employer now?

Yes
No

Employer Name

Type of Business

Address

Street Address Address Line 2 City State ZIP Code

Job Title

Type of Employment

Full-Time
Part-Time

Start Date

End Date

Your Duties

Supervisor

First Last

Supervisor Phone Number

Starting Salary

Ending Salary

Reason for Leaving

May we contact this employer now?

Yes
No

Employer Name

Type of Business

Address

Street Address Address Line 2 City State ZIP Code

Job Title

Type of Employment

Full-Time
Part-Time

Start Date

End Date

Your Duties

Supervisor

First Last

Supervisor Phone Number

Starting Salary

Ending Salary

Reason for Leaving

May we contact this employer now?

Yes
No

Employer Name

Type of Business

Address

Street Address Address Line 2 City State ZIP Code

Job Title

Type of Employment

Full-Time
Part-Time

Start Date

End Date

Your Duties

Supervisor

First Last

Supervisor Phone Number

Starting Salary

Ending Salary

Reason for Leaving

May we contact this employer now?

Yes
No

Personal References

(Do not list current or previous employers or relatives)

Name

First Last

Phone

Occupation

Email

Years Known

Name

First Last

Phone

Occupation

Email

Years Known

Name

First Last

Phone

Occupation

Email

Years Known

Have you ever been convicted of any violations of law other than minor traffic violations?

Yes
No

If yes, for what have you been convicted, when, where and penalty imposed?

Note: Convictions are not an automatic bar to employment, but are reviewed in relation to the job for which you applied. Convictions not reported may be cause for discharge.

Applicant Please Read Carefully and Sign Below

CAREFULLY READ THIS APPLICATION AND YOUR ANSWERS AND THE CERTIFICATION AND AGREEMENT BELOW BEFORE SIGNING. APPLICANT’S CERTIFICATION AND AGREEMENT

I certify that answers given herein are true and complete to the best of my knowledge. I understand and agree that any misstatements or omissions of material fact herein subjects me to disqualification or dismissal.

I authorize the Village of Mukwonago to make such investigations and inquiries of my personal employment, financial and other related matters as may be necessary at arriving at an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application. A copy of this authorization shall be effective as the original.

I authorize the Village of Mukwonago to make such investigation of my medical history, as may be necessary only after I have received a conditional job offer by the Village of Mukwonago.

I further understand that in the event of employment by the Village of Mukwonago, my classification as a permanent employee depends upon my successfully performing work assigned me during a probationary period, where applicable.

I also understand that covered employees are compensated for overtime work in accordance with the Fair Labor Standards Act. Applicants should discuss overtime pay practices with the appointing authority prior to accepting employment with the Village of Mukwonago.

Signature

Thank you for completing this application and for your interest in employment with us. We would like to assure you that your opportunity for employment with the Village of Mukwonago will be based on your merit and qualifications and no other consideration.

Date

Village of Mukwonago Employment Application

Personal Information

Education and Training

Training Beyond High School (College or University, Business College or other schools you have attended)

Employment History

Personal References

Applicant Please Read Carefully and Sign Below