Job Application

Personal Information

The following question is not designed to elicit information about a disability. Do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Answering “yes” to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be taken into account. 

Employment History

Starting with your most recent employer, provide the following information.

Previous Employer #1

Previous Employer #2

Previous Employer #3

Educational Background


Applicant Certification

I certify that all of the information I have submitted on this application is true and complete, and I understand that if any false or misleading information, omissions or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time.

I understand that the City of West Union may, in its sole discretion, conduct or have conducted by an individual or entity of its choice, a criminal background history and driving record search on all employees. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

If hired, I agree to conform to City of West Union’s rules and regulations, and I understand that these rules and/or the employee handbook do not form a contract of employment either expressed or implied, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or City of West Union’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at any time by the City of West Union.

I expressly authorize, without reservation, the City of West Union, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview.

I hereby waive any and all rights and claims I may have regarding the City of West Union, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

The City of West Union does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status under the applicable federal, state, or local law. The City of West Union likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, genetic information, age, disability, or any other protected status and takes all complaints of harassment seriously. All complaints will be investigated promptly and thoroughly.

I understand that this application remains current for thirty (30) days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new employment application.

I agree that my electronic signature on this application is binding and enforceable, as if I had signed a paper copy. I acknowledge and agree that by submitting this electronic signature, I waive all rights to dispute the validity of my signature on this application.


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