APPLICATION FOR EMPLOYMENT

CITY OF KENNER, CIVIL SERVICE 1801 WILLIAMS BLVD., KENNER, LA 70062

Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status

JOB TITLE (See Examination Announcement):
CONSTRUCTION WORKER II(ANNOUNCEMENT 294 - Entrance & Promotional)
Last name First Middle
Date of Entry
04/19/2014
Street Address
Home Phone
()
City, State, Zip
, ,
Business Phone
()
How did you learn of our organization?
Social Security No.
Are you legally eligible for employment in the United States?
Yes No
CHECK BOXES BELOW FOR LOCATIONS AND CONDITIONS OF EMPLOYMENT INTEREST. YOU WILL ONLY BE CONSIDERED FOR THOSE CHECKED.
Permanent Temporary Full-Time Part-Time
Shift Work On-Call/Hourly Summer/Seasonal
Have you ever been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court? Yes No If Yes, describe in full
Are you eighteen (18) years of age or older? Yes No
Do you have a valid Louisiana Driver's License? Yes No If yes, what class?
Were you ever fired or asked to resign from any job? Yes No If yes, please explain
Do you currently hold or are you a candidate for any elective office? Yes No If yes, please explain
SCHOOL
NAME AND LOCATION OF SCHOOL
COURSE OF STUDY
NO. OF
YEARS
COM-
PLETED
DID YOU
GRADUATE?
DEGREE
OR DIPLOMA
Post Grad
Yes
No
College
Yes
No
High
Yes
No
Other
Yes
No
LIST PROFESSIONAL CERTIFICATIONS AND LICENSES
(Exclude those which may disclose your race, color, religion or national origin)
Are members of your immediate family (parent, brothers, sisters, children, spouse, spouse of children) presently employed by the City of Kenner? Yes No
(If yes, list all below.)
Name:Relationship:Employing Department:

List any other last names you have used:
APPLICATION FOR VETERAN'S PREFERENCE

I hereby apply for Veteran's Preference as a: (check one)
Veteran (proof 1, below) Widow or Widower of Veteran (proof 1 & 4, below) Disabled Veteran (proof 1 & 2, below)
Spouse of Disabled Veteran (proof 1 & 3, below) Mother of Veteran, Deceased or Disabled {Serv. Con.}(proof 1 and, 2 or 4, below)

One or more of the following must be submitted in support of claim for Veteran's Preference:
1.True copy of honorable discharge or discharge under honorable conditions, establishing active service between September 16, 1940 and July 25, 1947; or, June 27, 1950 and January 31, 1955; or, July 1, 1958 and May 7, 1975 ( however the period of July 1, 1958 and August 4, 1964 is considered a wartime period only for those who served within the area known as the Vietnam Theater); or, August 2, 1990 through the end of the Persian Gulf War as prescribed by the presidential proclamation or concurrent resolution of Congress (however this period applies only to those persons in the armed forces who received the Southwest Asia Service Medal); or, Any period beginning on the date of any future declaration of war by the Congress and ending on a date prescribed by presidential proclamation or concurrent resolution of Congress.
2.Certificate of existing disability (dated within the past year) for service connected disability.
3.Statement from physician that veteran is unable to perform regular occupational duties, or certification that veteran is permanently and totally disabled.
4.True copy of veteran's death certificate.

EMPLOYMENT

Please give accurate, complete full-time and part-time employment record. Start with present or most recent employer

We may contact the employers listed above except for your present employer.
SPECIAL ACCOMMODATIONS: List any special accomodations you may need for testing purposes. (e.g. reader, interpreter, etc.)


STATISTICAL INFORMATION:The following information is used only for statistical purposes, to complete equal employment opportunity reports required by law.
Race/Ethnic Group: (check one)
White Black Hispanic Asian/Pacific Islander American Indian/Alaskan Native

Sex: (check one)
Male Female

Date of Birth:
AN EQUAL OPPORTUNITY EMPLOYER
I recognize that all of the above information is used as a basis for employment qualification. I hereby certify that the information provided in this Application for Examination is true, correct and complete to the best of my knowledge and that the residence address given is my permanent residence address; I further agree to notify the Civil Service Department promptly of any changes. I understand that false or misleading information may result in disqualification for employment and if employed, may result in my dismissal.

If you decide to engage an investigative consumer-reporting agency to report on my credit and personal history I authorize you to do so. If a report is obtained you must provide, at my request, the name and address of the agency so I may obtain from them the nature and substance of the information contained in the report.

I attest to the accuracy of the information submitted, to the best of my knowledge. I further agree to the conditions above.   Initials: