* Indicates Required Fields

EMPLOYMENT APPLICATION

Position Applied For

(one position per application):

  

*Who referred you to South Jordan City?    [Check a box below]

South Jordan Employee (name)

South Jordan Website Newspaper Website Newspaper

Job Posting DWS   Other Website

Other:

Date of

Application
Name
*Last *First Middle
           

*Mailing Address (Street or P.O. Box)

  

*City

 

*State

*Zip Code

*Day Phone:

 

*Evening Phone:        

                                                                           

*Mobile Phone:

  

E-Mail Address:

  

Have you ever worked or volunteered for South Jordan City?
Yes  No    From:   To:    

Position:  

*Are you Claiming Veteran's employment Rights?
Yes  No   

If so, you must attach a copy of form DD-214 to this application.

Have you ever applied for a position at South Jordan City? Yes No

If yes, give date & position: 

  

Are you willing to work shift work if the job requires it?    Yes        No

  

What is your shift preference?

  Days     Swing   

Are you willing to work a schedule that includes weekends and/or holidays?

                                 Yes     No

Do you have a valid Driver's License?

 Yes         No

*If offered a position requiring a driver's license, your driving record will be reviewed.

Drivers License Type or Class

  

  

Any applicable endorsements?

  

Criminal Background

  

Have you, since the age of 18, ever been convicted of a crime, excluding minor traffic offenses? Yes     No

*Criminal conviction is not an absolute bar from employment, but it will be considered in relation to specific job duties.

  

Have you engaged in illegal use, possession, sale, or transfer of narcotics or illicit drugs during the past 5 years, including receiving a positive drug test or positive workplace related alcohol test? Yes      No

  

If yes, please explain below and give dates, details, and penalties for each occurrence.  Please include dates of any  probationary periods. 

Have you ever been discharged or forced to resign from a

position?       Yes     No 

 If yes, please explain in detail below.

 

Are you aware of any reason why you cannot perform the

essential functions or meet the attendance requirements of the

job for which you are applying, with or without reasonable

accommodation?  Yes     No

If yes, please explain in detail below.

 

What is the lowest entrance salary you will accept?  $ per hour.

Note:  You may not be interviewed for the position if the starting salary pay is less than you indicated.

  

Do you have any relatives working for South Jordan City including biological, step, in-laws, or relatives by marriage?

Yes   No

If yes, please provide name and relationship:

  

  

  

EDUCATION AND SPECIAL SKILLS

High School Graduate, GED, or equivalent? Yes     No                                                                                            

If no, select highest grade completed:           

Name of High School      Location of High School

College/University/Technical College graduate? Yes      No               How many years attended? 

College, University , or Technical College Attended

Location of School (City)

Major/Minor or Field and Degree (if applicable)

  

  

  

  

  

  

  

  

  

  

  

  

Additional Skills & Qualifications

Use this area to list any additional information you think would be help us evaluate your application.  Include special skills, training, licenses, and certifications that you possess that will aide you in performing the essential job-related functions of the position you are applying for (i.e.; computer classes, CDL, P.O.S.T. certification, EMT or Paramedic licensing, lifeguard certifications, heavy equipment or landscaping equipment experience.)

  

  

  

  

  

EXPERIENCE   Do not use “See Resume”

Beginning with present or most recent experience, account for all employment during the LAST 10 YEARS.  If you wish to elaborate on your experience, a supplemental sheet or resume may be attached.  Include military service, if applicable; also include non-paid (volunteer type) employment.                                

If no previous work experience, check here

Employer

Date

From:  To: 

Your Name While Employed

Job Title

Address (Street)

City

State

Zip

Telephone Number

Supervisor’s Name

May we contact for a reference?

 Yes  No  Later

Starting Salary

$   Year /  Hour

Ending Salary

$  Year /  Hour

Responsibilities and Duties:

Reason for Leaving:                                                                                          

Employer

Date

From:  To: 

Your Name While Employed

Job Title

Address (Street)

City

State

Zip

Telephone Number

Supervisor’s Name

May we contact for a reference?

 Yes  No  Later

Starting Salary

$   Year /  Hour

Ending Salary

$  Year /  Hour

Responsibilities and Duties:

Reason for Leaving:                                                                                          

Employer

Date

From:  To: 

Your Name While Employed

Job Title

Address (Street)

City

State

Zip

Telephone Number

Supervisor’s Name

May we contact for a reference?

 Yes  No  Later

Starting Salary

$   Year /  Hour

Ending Salary

$  Year /  Hour

Responsibilities and Duties:

Reason for Leaving:                                                                                          

REFERENCES

List the names and telephone numbers of three business/work references that are not related to you.

Name

Profession/Title

Daytime Telephone Number

Years Known

  

1.

  

  

 

  

 

  

2.

  

  

 

  

 

  

3.   

 

  

 

  

 

Are you at least 16 years old? Yes No      (All City employees must be a minimum of 16 years old) 

Attach a copy of your résumé: (Optional)

THE CITY OF SOUTH JORDAN IS AN EQUAL OPPORTUNITY EMPLOYER

It is the policy of South Jordan City to recruit, hire, and promote qualified applicants without regard to their race, color, religion, sex, national origin, disability, or other areas covered by federal, state, or local fair employment laws and regulations.  To further this objective, the city has established procedures to ensure that all personnel actions such as compensation, benefits, transfers, employer sponsored training and education, educational assistance, social and recreational programs, and use of all employee facilities are administered without regard to race, color, religion, sex, national origin, or disability.  If you are invited for an interview, testing, etc., and, due to a disability, need assistance in understanding and participating in the process, please notify the Human Resource Office at (801) 254-3742 .

Equal Employment
Opportunity Information
The information below is needed to measure the effectiveness of our recruitment efforts and to help us conform with federal government guidelines, which require us to compile statistical information about applicants for employment. You are not required to furnish this information, but are encouraged to do so. This information will not influence selection and will not be used as a basis for selection; it is merely for statistical purposes.
This information sheet will be detached from the application prior to being processed for
consideration and will be kept in a confidential file separate from the Employment Application.

Position applied for: Firefighter EMT Basic/Intermediate (Full-time/Benefits) 10.26.2009      Date: 11/22/2009

Please mark appropriately: Male Female

Are you 40 years or older? Yes No

ETHNIC CATEGORY (Please check one):

  • WHITE (not of Hispanic origin): All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
  • BLACK (not of Hispanic origin): All persons having origins in any of the Black racial groups of Africa.
  • HISPANIC: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
  • ASIAN OR PACIFIC ISLANDER: All persons having origins in any of the original people of the far East, Southeast Asia, Indian Sub continent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa.
  • AMERICAN INDIAN OR ALASKAN NATIVE: All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliations or community recognition.
VETERAN'S ELIGIBILITY
Pursuant to Utah State Code, South Jordan City grants Veteran's preference during hiring process. NOTE: You must use the Application to claim Veteran's Preference. Designating your Veteran's status here will not provide you with hiring preference.
  • A) Any individual who has served on active duty in the armed forces for more than 180 consecutive days, or was a member of a reserve component who served in a campaign or expedition for which a campaign medal has been authorized and who has been separated or retired under honorable conditions.
  • B) A disabled veteran with any percentage of disability.
  • C) The spouse or unmarried widow or widower of a veteran.
  • D) A Purple Heart recipient.
  • E) A retired member of the armed forces who retired below the rank of major or its equivalent.

CERTIFICATION OF APPLICANT

READ CAREFULLY BEFORE SIGNING

I AUTHORIZE THE INVESTIGATION OF ALL PRIOR EMPLOYMENT RECORDS AND INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION, RESUME, AND/OR STATEMENTS MADE IN THE INTERVIEWING PROCESS.  I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS IN THIS APPLICATION MAY BE CAUSE FOR DISQUALIFICATION AND/OR SEPARATION FROM EMPLOYMENT.

   I Certify and Agree to All of the Above Information