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APPLICATION FOR EMPLOYMENT
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
First Name*
Last Name*
Mailing Address*
City*
State*
Zip*
Physical Address (if different than mailing address)
City
State
Zip
Phone Numbers*
Email Address*
Are you prevented from lawfully becoming employed in this country?*
(Proof of citizenship or immigration status will be required upon employment)
1. Yes
1. No
Do you currently have any relatives employed by the Town?*
1. Yes
1. No
If yes, give their relationship and name:
Have you ever been employed by the Town of Wickenburg?*
1. Yes
1. No
If yes, give dates and positions:
Have you ever been convicted of a felony, misdemeanor or serious driving offense, regardless of whether the conviction was later set aside or expunged, in any domestic, foreign or military court (this does not include minor civil traffic offenses)? *
Conviction will not necessarily disqualify an applicant from employment.
1. Yes
1. No
If yes, please explain:
Are you pending charges, trial or other court proceedings for a felony, misdemeanor or serious driving offense in any jurisdiction at this time? *
1. Yes
1. No
If yes, please state charge, date and Jurisdiction:
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Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status. Please do not write, see resume. Please include at least the past 10 years.
Employer
Job Title
Address
City
State
Phone Number
Supervisor
Supervisor's Phone Number
Employed From - To (Dates)
Salary
Work Performed
Reason for Leaving
Employer
Job Title
Address
City
State
Phone Number
Supervisor
Supervisor's Phone Number
Employed From - To (Dates)
Salary
Work Performed
Reason for Leaving
Employer
Job Title
Address
City
State
Phone Number
Supervisor
Supervisor's Phone Number
Employed From - To (Dates)
Salary
Work Performed
Reason for Leaving
Employer
Job Title
Address
City
State
Phone Number
Supervisor
Supervisor's Phone Number
Employeed From - To (Dates)
Salary
Work Performed
Reason for Leaving
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I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed one year. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the Town of Wickenburg is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. 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 Town of Wickenburg.
Applicant Signature*
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
If you need reasonable accommodations, please notify the Town.

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