APPLICATION FOR EMPLOYMENT
CITY OF STATESBORO
P.O. Box 348
Statesboro, GA 30459
(912) 764-5468
The City of Statesboro is an equal opportunity employer and will not discriminate, or tolerate discrimination, against any employee or applicant in any manner prohibited by law.
Instructions: Complete a separate application form for each position you are applying for, unless otherwise specified. An employment application, unless otherwise specified, will be accepted only when a specific position opportunity notice is posted on the job vacancy board or City of Statesboro website, or advertised in various publications. Complete the application in its entirety. Print clearly or type your responses using black or blue ink. Resumes will not be accepted in lieu of completion of this application for employment. Incomplete applications will not be processed.

Position applied for:

Social Security Number:

Please write your name as it appears on your social security card:

Name:
Last

First

Middle

Address:

Home Phone #:

Number

Street

___

Apt. #

Business Phone #: ________________________
City

State

Zip Code

Email Address:

Cell Phone #:

__

Please list any other name(s) you have used for school or employment:

Have you ever worked for the City of Statesboro?
Yes___ No___ If yes, indicate when and in which department(s) below:

Are you related to any person currently employed by the
City of Statesboro? Yes___
No___
If yes, indicate name, relationship, and department
_

Are you at least 18 years of age? Yes___ No___
Do you have a valid driver’s license? Yes___ No___
State of Issuance:
________
Driver’s License Number:
________ __
Date of Expiration:
Class:
Please indicate any professional/occupational license(s) you currently hold. If this doesn’t apply to you check here_____

Ever applied with the City of Statesboro? Yes___ No___
If so, When? ____________ Which Dept? __________

License: ________________________________________
State of Issuance:
License Number:
Date of Issuance:
Date of Expiration:

Have you ever served on active duty with U.S. Armed

Please list your desired salary: _______________________

Forces?

Yes___ No___

Dates of Duty: From_____________ To ______________
Type of Discharge:________________________________
Final rank: ______________________________________

Have you ever been fired, or resigned in lieu of termination? Yes___

No___

If yes please explain:

Employment desired:
Full-Time
Temporary

Part-Time
Seasonal

Can you provide the documents required to prove that you are authorized to work in the United States? Yes__ No__

EDUCATION AND SPECIAL TRAINING
Do you have a High School Diploma? Yes___ No___

GED? Yes___No____

If not, highest grade completed:
Name and location of last High School attended:
Name

City

State

List Special Training (Business, Trade, Vocational, Armed Forces Schools, etc.) below:
Total Hours Hours required
Completed
for certification
Name and Location
Course/Subject Taken
Certificates Received

List Colleges and Universities attended below:
Credit Hours
Did you
Received
Name and Location
Graduate?
Sem.
Qtr.
Yes
No

Major/Minor Degree
Field of Program of Study

Type of
Degree Received

Language Skills: In what languages, other than English, are you proficient? Please list language(s) and check areas that are applicable.
Language
Read
Speak
Write
Understand

Computer Skills and Abilities: List computer software with which you have knowledge and experience:

EMPLOYMENT HISTORY:
List all of your employment experience within the past ten years, beginning with your current or most recent employer. Include military experience. You may include experience beyond ten years minimum if the previous experience is applicable to the job for which you are applying. Please make copies of the next page if additional space