CITY OF HATTIESBURG
CIVIL SERVICE COMMISSION
The City of Hattiesburg is an equal opportunity employer and does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age or disability in employment. Applicants considered for employment will be required to present verification of employment eligibility as required by the Immigration Reform and Control Act. All applicants offered a position with the City of Hattiesburg will be required to successfully pass a drug/alcohol test before the offer of employment is confirmed.
Date of Application
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Position Being Applied For the
Entry Level, Laterals or Part-Time
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Entry Level
Lateral
Part-Time
Instructions to Applicant:
Answer each item completely. Failure to provide complete information may result in rejection of this application. Identify all the details in your experience, education, and training that will indicate your qualifications for the position you are seeking. All information will be kept strictly confidential.
PERSONAL INFORMATION
Name:
*
Last First Middle
Social Security No.
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Email Address
*
Date of Birth
*
Phone Number
*
Are you applying for a Fire Academy position?
*
Yes
No
Height
*
Weight
*
Are you a United States citizen?
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Yes
No
Are you a resident of the City of Hattiesburg?
*
Yes
No
Are you a registered voter in your county of residence?
*
Yes
No
Voting Precint
*
Do you have a valid driver's license?
*
Yes
No
Do you have a valid commercial driver's license?
*
Yes
No
License Number
*
Issuing State
*
Expiration Date
*
Have you ever been convicted of a felony?
*
Yes
No
Give the details of each charge and the status or disposition of each charge below. Click on Add to add additional convictions:
Date of Conviction
*
Felony, Misdemeanor, or Non Applicable
*
Location (City, State) of Conviction
*
Describe Nature of Offense
*
Row 1
Felony
Misdemeanor
Not Applicable
Add
Please list personal references below (do not list relatives or previous employers)
Name
*
Phone Number
*
Address
*
Relationship to you
*
EDUCATION AND TRAINING
Did you attend high school?
*
Yes
No
Years in School
*
Name of School & Course
*
Dates Attended
*
Graduate?
*
High School
9th Grade
10th Grade
11th Grade
12th Grade
Yes
No
Did you attend junior college or vocational tech school?
*
Yes
No
Years in School
*
Name of School & Course
*
Dates Attended
*
Graduate?
*
Junior College/Vocational Tech
1 Year
2 Years
3 Years
4 Years
Yes
No
Did you attend college or university?
*
Yes
No
Years in School
*
Name of School & Course
*
Dates Attended
*
Graduate?
*
College or University
1 Year
2 Years
3 Years
4 Years
Yes
No
Did you attend any additional college?
*
Yes
No
Years in School
*
Name of School & Course
*
Dates Attended
*
Graduate?
*
Additional College
1 Year
2 Years
3 Years
4 Years
Yes
No
Describe any additional education, training, or apprenticeship, and describe your major
*
Upload resume and certifications
*
EXPERIENCE
Show in the spaces below employment you have had during the past ten years, including your present employment. Click on Add to add additional employments.
Date Started
*
Date Ended
*
Name of Employer
*
Address of Employer
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Salary Per Month
*
Nature of Duties
*
Reason for Leaving
*
Add
Describe any special qualifications in training and experience you have had that, in your opinion, will better qualify you for the position for which this application is filed:
*
Have you served or are you serving in the U.S. Military?
*
Yes
No
Branch of Service
*
Years of Service
*
Type of Discharge received (Please furnish a copy of your DD-214)
*
Upload DD-214
*
Do you have any objection to taking a polygraph examination?
*
Yes
No
Do you have any objection to the City of Hattiesburg making inquiry regarding your character, qualifications, etc. of your present employer?
*
Yes
No
Additional comments (if needed)
In filling out this application for employment, I authorize the City of Hattiesburg to inquire into all statements made in this application, with full knowledge that any misrepresentation or omission of facts will prejudice my application for employment and may, If I become employed, be sufficient cause for dismissal from the City's service. If I should become employed, I agree to abide by all the rules and policies of the City of Hattiesburg and I understand I will be on probation for the first twelve (12) months of employment. I understand that as a part of normal procedure for processing employment applications and employment requests, a routine inquiry may be made concerning information on character, general reputation and personal qualifications. I authorize the City of Hattiesburg to obtain or release any information pertaining to my arrest or past employment records. This release is executed with full knowledge and understanding that the information is for the official use of the bearer. I release you, as the custodian of these records, including any officers, employees, or related personnel, both individually and collectively, from any and all liability for damages of whatever kind which may at any time result to me, my heirs, family or associates because of compliance with this authorization request to release information, or any attempt to comply with it. I am furnishing my social security account number on a voluntary basis with the understanding such is not required by Federal statute or regulation. I have been advised the City of Hattiesburg or any other agency will utilize this number only to facilitate the location of past employment or arrest records. Should there be any question as to the validity of this release, you may contact me as indicated below. During same, I may be terminated at the will of the City of Hattiesburg.
Date
*
Full Name:
*
This is considered your signature
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