Agenda Packets - 1995/09/26 - Laserfiche WebLink

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THIRD LAST EMPLOYER ADDRESS ZIP CODE PRONE I MI/Lien kiD S' 0405 G xiie(( 4U SUPERVISOR'S NAME AND TITLE MAY WE CONTACT? IF NO PLEASE EXPLAIN /Y1. rki= Fox 4411-1-- )r10d1 ek �f c ---- C' . 410Y l� EMPLOYMENT DATES LAST SALARY / ,�>_3 REASON FOR LEAVING JOB TITLE FROM go TO g2. /0�7S Y/fZr - PART TIME ( �, f��r,�G/ar701 Ai1213/(j n SPECIFIC DUTIES -{`f //¢Q/L]t — 6.00// ex S — ,2ec i /41- /142,e/1 19 .P 'f )71,467ii GC'O OTHER EXPERIENCES/SKILLS LIST ANY OTHER SKILLS OR EXPERIENCES WHICH RELATE TO THIS POSITION, INCLUDING COMPUTER HARDWARE AND SOFTWARE. MILITARY — Complete this l section only if you served6� in the armed .forces. Branch of service: tS/i L� I Length of time served:9. Yef1rd Type of discharge: hfj//6Y`A6,/,d when: 7oj Describe your duties and special training: ,O'0(J2 ce .c -- 7/cmc rc 5 — tt_ 1 S 5 pn7 r rev on'e ke, i, /r o /11'9,7t-/J 41 Do you qualify for veterans preference points?g5 Provide a copy of Form DD214 and military discharge documents STATEMENT OF INTEREST — give a brief statement of why you are interested in and feel you are qualified for the position(s) for which you are applying fi/ri SA- // 6 SDLP ' 2d frvatPn //10 /Vrpe #1/ GU/7`G, !4 SS7/G/1y c:S(/ 7U ccj ecU ( y fl rm/np Ge./e// / i i, ?j/fi)r,+ 1/c f A/f��d�, u�c�/'�c�vn ) o.7-- 4_5- ,15 5,15 my Abeliily 2l cud* a(/1cto2S- LIST ANY RELATIVES CURRENTLY EMPLOYED WITH THE CITY OF MOUNDS VIEW (excluding spouse) NAME RELATIONSHIP PERSONAL REFERENCES (not relatives or former employers) NAME ADDRESS INCLUDING CITY, STATE, ZIP CODE PHONE +1 BUSINESS OR OCCUPATION 00 CS p v ot_ 5-5-7 3-th a yC: now (3rvit X33� - doo(c. 2. (1'hk CC-1/044/16t-ter 7Z1.. 5 5' Pi iL flu ) 7 4=-7 eih 2E4 '55 3. HOWAf/le /'1455- • /13E . nF•er2),► 20 S'E, eVVL mn.s5 V- qow 0.2 I hereby certify that all answers to the above questions are true and I agree and understand any false inforsation contained in IN:this application say cause refection of this application or termination of employment. I understand all of the inforsation on application is subject to verification. i authorize schools, former and current esployere, and references listed above to provide s record, reason for issuing, and all other inforsation they ■a have concerning se and I release all parties from any and all liability and clause for damage whatsoever that ■ay result therefrom. I understand that to qualify for regular employment, I must submit and pass a physical examination by a City designated doctor. I also agree that in the event I a■ employed by the City, I will submit to further physical examinations when requested by the City. I do not know of any reason why I would not be able to perform the duties and tasks of this position as outlined In the job description. APPLICANT'S SIGNATURE • /A DATE _ �?