Application Form

Personal Information

(If offered employment, you will be required to provide documentation to verify eligibility.)

EDUCATION

Other Training or Degrees:

Professional License or Membership

(You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status.)

Skills

Employment

List last employer first, including U.S. Military Service.

PROFESSIONAL References ONLY:

APPLICANT'S CERTIFICATION AND AGREEMENT

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize the Town of Gate City to verify their accuracy and to obtain reference information on my work performance. I hereby release the Town of Gate City from any/all liability of whatever kind and nature which, at any time, could result from obtaining and basing an employment decision on such information. I understand that falsified statements of any kind or omissions of facts called for on this application may result in disqualification for consideration for employment or, if already employed, grounds for immediate dismissal. I understand that should an employment offer be extended to me and accepted, I will fully adhere to the policies, rules and regulations of employment of the Town of Gate City. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Town of Gate City may terminate my employment at any time with or without notice or cause.