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New Applicant Form

  1. 1. PERSONAL DATA

  2. Do you have a valid Driver's License?*

  3. 2. PHYSICAL CONDITIONS OR LIMITATIONS

  4. Do you have any physical condition or limitations that would prevent you from performing all the duties of this position on a regular and continuing basis?

  5. 3. PREVIOUS CITY EMPLOYMENT AND CURRENT EMPLOYMENT OF A RELATIVE

  6. A. Have you been previously employed by the City of West Columbia?

  7. B. Are you currently participating in the Public Employees Retirement System?

  8. C. Have you ever participated in the Public Employee's Retirement System?

  9. 4. EDUCATION AND TRAINING

  10. Are You A High School Grad?

  11. Have You Passed the GED?

  12. Special Skills:

  13. 5. WORK EXPERIENCE

    You should respond completely to the information requested n this section and attempt to cover all the requirements listed in the job announcements. LIST YOUR MOST RECENT EMPLOYMENT FIRST. Describe different positions held with the same employer in different blocks, showing dates, etc. List all experiences, paid and voluntary, related to the position for which you are applying. Additional sheets should be attached to this application when necessary to fully describe related experience, training and education. DO NOT ENTER "SEE RESUME"

  14. A.

  15. B.

  16. C.

  17. D.

  18. E.

  19. Use this space to provide additional information as required by this application. Attach additional sheets if necessary.

  20. 7. CONVICTION RECORD (REQUIRED FROM ALL APPLICANTS)

    Answer this section truthfully, including both minor and serious offenses of which you were convicted. ANY OMISSIONS ARE GROUNDS FOR REJECTION OF THE APPLICATION, REMOVAL OF NAME FROM THE ELIGIBILITY LIST OR DISMISSAL FROM POSITIION.

  21. Have you ever been convicted as an adult for any violation of the law? Exclude traffic violations under $200 and convictions more than two years old for violation of Health and Safety Code 11357(b), 11360(b), 11364, 11365 and 11550 as related to marijuana. You may also exclude any convictions whuch resulted in a referral to and participation in any diversion program. Conviction is not necessarily a bar to employment. Each case will be given individual consideration. Failure to list all convictions other than those excluded above may disqualify you from further consideration.

    If yes, provide the information requested below for each conviction. Be specific, give name of the offense, not simply misdemeanor or felony. DO NOT LIST ARRESTS - ONLY CONVICTIONS.

  22. 8. CERTIFICATE OF APPLICANT - PLEASE READ CAREFULLY

  23. IF APPOINTED TO A CITY JOB, APPLICANTS WILL BE REQUIRED TO SUBMIT PROOF OF IDENTITY AND ELIGIBILITY TO WORK IN THE UNITED STATES. PRIOR TO HIRING, A CANDIDATE WILL BE REQUIRED TO BE DRUG-TESTED AT CITY EXPENSE. FOR SOME POSITIONS, A FULL MEDICAL AND PSYCHOLOGICAL EVALUATION AND DETAILED BACKGROUND INVESTIGATION WILL BE REQUIRED. CONVICTION RECORDS WILL BE CHECKED.

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  25. This field is not part of the form submission.