CITY OF NEWPORT						APPLICATION FOR EMPLOYMENT
The City of Newport considers applicants for all positions without regard to race, color, sex, age, religion, national origin, disability, marital status or any other legally protected status
(Please Print)
Position Applied For (Specific Job Title)						Date of Application
PERSONAL DATA
Last Name		First Name		Middle		Home Phone		Message Phone
						(      )		(     )
Address			City		State		Zip	Business Phone
								(     )
Social Security Number			State Age if you are under 18____________
			(State Law requires work permits for those age 14-17)
Are you a citizen of the United States or an alien authorized to work in the U.S.?   ____ Yes  ____ No
(Proof of U.S. Citizenship or Immigration Status will be Required Upon Employment)
Have you ever been employed by the City of Newport before?  ____  Yes  ____ No                                                                                 If Yes, please provide dates and position title__________________________________________________
Have you been convicted of a felony within the last seven (7) years?  ____ Yes  ____ No
(NOTE: A conviction will not necessarily bar you from employment.  A conviction will be judged on its own merits with respect to time, circumstances & seriousness.)
If Yes, please explain _____________________________________________________________________
EDUCATION
		Name and Address						Years	Diploma/
		of School			Course of Study			Completed	Degree
High
School
Undergraduate
College
Graduate
Professional
Other
(Specify)
SKILLS AND ABILITIES
LIST YOUR SPECIFIC SKILLS WHICH ARE PERTINENT TO THE POSITION FOR WHICH YOU ARE APPPLYING. (Machines used, Bilingual skills, Equipment used, Certification, Licenses, Etc.)
WORK EXPERIENCE
Start with your present or last job. LIST ALL WORK EXPERIENCE including military, volunteer and intern experience.  IF YOU NEED ADDITIONAL SPACE, PLEASE CONTINUE ON A SEPARATE SHEET OF PAPER
Present or Last Employer				Address
Type of Business				Supervisor's Name		Title		Phone
Your Title				Reason for Leaving
Duties (Be specific):								Starting Date
								Month	Year
								Leaving Date
								Month	Year
								Salary $__________/month
Next Previous Employer				Address
Type of Business				Supervisor's Name		Title		Phone
Your Title				Reason for Leaving
Duties (Be specific):								Starting Date
								Month	Year
								Leaving Date
								Month	Year
								Salary $__________/month
Next Previous Employer				Address
Type of Business				Supervisor's Name		Title		Phone
Your Title				Reason for Leaving
Duties (Be specific):								Starting Date
								Month	Year
								Leaving Date
								Month	Year
								Salary $__________/month
Next Previous Employer				Address
Type of Business				Supervisor's Name		Title		Phone
Your Title				Reason for Leaving
Duties (Be specific):								Starting Date
								Month	Year
								Leaving Date
								Month	Year
								Salary $__________/month
BUSINESS/WORK REFERENCES
List name, address and telephone number of three (3) BUSINESS/WORK REFERENCES who are NOT related to you.  If not applicable, list three (3) school or personal references who are NOT related to you.
Name and Occupation				Address				Phone Number
By my signature below, I certify that all answers to the questions and statements on the application are true and complete to the best of my knowledge.  I understand that should the City learn, at any time, of any untruthful or misleading answers, my application may be rejected, my name removed from consideration, or my employment with the City terminated.  I hereby authorize past/present employers and educational institutions to release information concerning my work or educational history to be used solely in determining my qualifications for this position.
Signature:___________________________________________  Date:_______________________________
	PRE-EMPLOYMENT SUBSTANCE (DRUG) SCREENING MAY BE REQUIRED
AN EMPLOYMENT OFFER MAY BE CONTINGENT ON PASSING A PHYSICAL EXAMINATION
		FOR SOME POSITION CLASSIFICATIONS.
AMERICANS WITH DISABILITIES ACT ACCOMMODATIONS WILL BE PROVIDED UPON REQUEST