All applications for the City of Trinidad employment must be made on this form. This application form and its attachments are official property of the City of Trinidad and will not be returned. If more space is needed to give full answers or explanations attach additional pages. All information requested must be complete and accurate. A false, incomplete or misleading response may result in disqualification for employment.

Telephone No.: ______________________    Driver's Lic. No./State: _____________________

CDL:   YES    Or    NO

I certify that all information contained on this application is true and complete to the best of my knowledge and belief. I understand that the employment process may include drug screening, work fitness examination, medical and psychological exam, and review of driving record. I give the City of Trinidad and its authorized agents permission to verify any job-related information given in connection with this application. All new hire applicants will be required to show proof of citizenship. I understand, if employed, that the City of Trinidad can change wages, benefits and conditions at any time. I further understand that my employment can be terminated, with or without cause, at any time at the discretion of the City, or myself. I further understand that no management official, other than the City Council, has the authority to enter into an agreement contrary to the foregoing or make any oral assurance or promise of continued employment.

Applicant=s signature: _______________________________   Date: ______________________

Applicants are considered for positions without regard to race, color, religion, sex, national origin, age, veteran status, or disability. The City of Trinidad may conduct preemployment qualification assessment testing. If you require accommodation for the testing process, you must notify Personnel when you submit your application.

Position applying for: ___________________________________________________________________________________

Applicants may be required to describe or demonstrate that they can perform job related functions.

Name: ________________________________________________________________________________________

Address: ______________________________________________________________________________________

Telephone number(s) you can be reached at when not at above number: _____________________________________

Please check all hours that you are available to work:

full time ____        part-time ____   temporary ____    days _____    Evenings/nights ____   weekends ____   shifts _____

Date available to start work: _______________________________________________________________________

Have you ever filed an application here before: yes (   )   no (   )   If yes, give date: ____________________________

If you answer AYes@ to any of the following questions, please explain in full.

1.  Are you now working for or have ever worked for another water district or City? _________________________

     If yes, please explain: _________________________________________________________________________

2. Do you or does your spouse have any relatives presently working or holding office for the City of Trinidad?____

     If yes, please explain: _________________________________________________________________________ 

3. Are you on a lay-off and subject to recall? ______________ If yes, please explain: _________________________

4. Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?_____

     If yes, please explain: _________________________________________________________________________

     (If offered employment with the City of Trinidad you will be required within three (3) business days of beginning        employment to produce original legal documents that establish your identity and employment eligibility.)

List any professional, trade, business or civic activities and offices held. (You may exclude any which indicate race, color, religion, sex or national original): 

Give name, address, and telephone number of three references who are not related to you and are not previous employers.

1.     ________________________________________________________________________

2.      ________________________________________________________________________

3.      _______________________________________________________________________

Have you ever been bonded? __________    If yes, for which position(s): ___________________________________

Have you ever been convicted of a felony? _________  If yes, please list convictions: _________________________

SPECIAL QUALIFICATIONS OR SKILLS: List qualifications and skills you may possess which are required for the job as stated in the job announcement, such as typing speed, ability to operate specialized machinery or equipment, or professional registration or licensing. Indicate any training you have had which is directly related to the job for which you are applying: 

List employers starting with the most recent. Include military service or volunteer work. Exclude organization names which indicate race, color, religion, sex, or national origin.

Employer: ____________________________________         Job Title: __________________________________

Street Address: ________________________________         City/State/Zip: _______________________________

Phone No.: ___________________________________          Supervisor: _________________________________

Beginning Employment Date: _____________________          Ending Employment Date: _____________________

Starting Hourly Rate/Salary: ______________________          Ending Hourly Rate/Salary: ____________________

Work Performed: _________________________________________________________________________Reason for leaving: ____________________________________________________

Employer: ____________________________________         Job Title: __________________________________

Street Address: ________________________________         City/State/Zip: ______________________________

Phone No.: ___________________________________          Supervisor: _________________________________

Beginning Employment Date: _____________________          Ending Employment Date: _____________________

Starting Hourly Rate/Salary: ______________________          Ending Hourly Rate/Salary: ____________________

Work Performed: _____________________________________________________________________________________________Reason for leaving: _____________________________________________________________________________

Employer: ____________________________________         Job Title: __________________________________

Street Address: ________________________________         City/State/Zip: ______________________________

Phone No.: ___________________________________          Supervisor: _________________________________

Beginning Employment Date: _____________________          Ending Employment Date: _____________________

Starting Hourly Rate/Salary: ______________________          Ending Hourly Rate/Salary: ____________________

Work Performed: _____________________________________________________________________________________________Reason for leaving: _____________________________________________________________________________

IF YOU NEED ADDITIONAL SPACE, PLEASE CONTINUE ON A SEPARATE SHEET OF PAPER.

Years Completed: (Circle)    9    10    11    12                Diploma: ______________________________

Years Completed: (Circle)    1    2    3    4                                 Degree: _______________________________

Years Completed: (Circle)    1    2    3    4                                 Degree: _______________________________

Describe Course of Study:________________________________________________________________________

Honors Received: ______________________________________________________________________________

State any additional information you feel may be helpful to us in considering your application: __________________

I CERTIFY THAT THE STATEMENTS CONTAINED HEREIN ARE TRUE, COMPLETE, AND CORRECT TO THE BEST OF MY KNOWLEDGE.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and is not intended to be a contract of employment.

In the event of employment, I understand that false or misleading information given in my application or interview (s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the City of Trinidad.