Instructions to Applicant:


    • Give the details of each charge and the status or disposition of each charge below. Click on Add to add additional convictions:

    • Please list personal references below (do not list relatives or previous employers)


    • High School
    • Junior College/Vocational Tech
    • College or University
    • Additional College


    • 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.


    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.

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