Economic Development Corporation CEO/Executive Director Application

EMPLOYMENT APPLICATION

Applicant's Full Name *

First

Middle

Last

Applicant's Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Number of years at the above address? *

Daytime Phone Number *

Evening Phone Number *

Mobile Phone Number *

Email Address *

Social Security Number *

Driver's License Number *

Driver's License State *

Who referred you to this opportunity?

Are you at least 18 years old? *

Yes
No

Do you own your own vehicle? *

Yes
No

Are you willing to work occasional nights or weekends if the need arises? *

Yes
No

If offered employment, when will you be able to start? *

If hired, are you able to submit proof that you are legally eligible for employment in the United States? *

Yes
No

Have you been convicted of a felony? *

Yes
No

EMPLOYMENT HISTORY

Please list the most recent employment first

Employer Name #1 *

Supervisor Name #1 *

Employer Address #1 *

Address Line 1

Address Line 2

City

State

Zip Code

Your Job Duties #1 *

Reason for Leaving #1 *

Dates of Employment #1 *

Please enter your begging and ending dates with this employer.

Employer Name #2

Supervisor Name #2 *

Employer Address #2 *

Address Line 1

Address Line 2

City

State

Zip Code

Your Job Duties #2 *

Reason for Leaving #2 *

Dates of Employment #2 *

Please enter your begging and ending dates with this employer.

Employer Name #3

Supervisor Name #3 *

Employer Address #3 *

Address Line 1

Address Line 2

City

State

Zip Code

Your Job Duties #3 *

Reason for Leaving #3 *

Dates of Employment #3 *

Please enter your begging and ending dates with this employer.

EDUCATRION AND TRAINING

High School Diploma or GED? *

High School Diploma
GED

Name of School for High School Diploma or GED *

Name of College or University Attended *

Degree Earned or Hours Completed *

Other Training or Certifications Earned *

References

Please provide two references and their contact information.

Reference 1 Name *

First

Last

Reference 1 Phone *

Reference 1 Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference 2 Name *

First

Last

Reference 2 Phone *

Reference 2 Address *

Address Line 1

Address Line 2

City

State

Zip Code

FILE UPLOADS

Resume *

Cover Letter (optional)

Additional Documentation (optional)

ACCURACY AND TRUTH STATEMENT

Checkboxes *

I certify that all answers given by me are true, accurate and complete. I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying documents) will be cause for denial of employment or termination of employment, regardless of when or how it was discovered.

DIGITAL SIGNATURE *

First

Middle

Last

EMPLOYMENT APPLICATION

EMPLOYMENT HISTORY

EDUCATRION AND TRAINING

References

FILE UPLOADS

ACCURACY AND TRUTH STATEMENT

Howdy from Breckenridge…

Phone Numbers

Addresses