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2. 
3. TOWN OF EAGLE
   200 Broadway * PO Box 609 Eagle CO 81631 (970) 328-6354 * (970) 328-5203 Fax
4. EMPLOYMENT APPLICATION
8. AN EQUAL OPPORTUNITY EMPLOYER
   We do not discriminate on the basis of race, color, religion, national origin, ancestry, age, sex, sexual orientation, disability, veteran status, genetic information, or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.
10. PLEASE COMPLETE ALL SECTIONS
    Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.
12. Position desired:*
    -- Select One --Administrative Technician II - Community DevelopmentDistribution and Collections Operator: Trainee, I, II, IIPolice OfficerPolice Records and Information Technician, I, IIWater Plant Operator
13. Today's Date*
    Today's Date
15. How did you learn about this position (if website, newspaper or staff member, please specify which one):*
17. Pay Expectation: *
19. First Name*
20. Last Name*
22. Mailing Address*
24. City*
25. State*
26. Zip*
28. Email Address*
29. Phone:*
31. Date available for work*
    Date available for work
32. Do you have valid driver's license?*

    1. Yes
    2. No
33. Issuing State: *
35. Are you 18 years of age or older? *

    1. Yes
    2. No
36. Have you ever been employed by the Town of Eagle?*

    1. Yes
    2. No
37. Are you eligible for employment in this Country*

    1. Yes
    2. No
39. High School/GED/ (Name/City & State)*
40. High School Diploma Received?*

    1. Yes
    2. No
41. GED

    1. Yes
    2. No
43. College or Other (Name/City & State)
44. Number of years completed
45. Certificate or Degree Received:

    1. Yes
    2. No
46. Courses or Major
48. College (Name/City & State)
49. Number of years completed
50. Degree received

    1. Yes
    2. No
51. Major
53. WHAT OTHER SKILLS, CERTIFICATIONS, EXPERIENCE AND/OR TRAINING DO YOU HAVE THAT RELATE TO THE JOB YOU ARE APPLYING
55. WHAT MACHINES OR EQUIPMENT CAN YOU OPERATE THAT RELATE TO THE JOB FOR WHICH YOU ARE APPLYING?
57. EMPLOYMENT HISTORY, ATTACH ADDITIONAL SHEET/RESUME IF NEEDED.

    Show most recent employment first, please include at minimum your last 10 years of employment (minimum 3-4 jobs). Account for all periods of time including military service, self-employment and any periods of unemployment. INCOMPLETE APPLICATIONS OR THOSE THAT STATE "SEE RESUME", WILL BE REJECTED, LEAVE NO BLANKS OR INDICATE N/A. NOTE: A JOB OFFER MAY BE CONTINGENT UPON ACCEPTABLE REFERENCES FROM FORMER EMPLOYERS.

59. Employed by: *
60. Your Job Title*
62. Address:
63. City*
64. State*
65. Supervisors Current Phone*
67. Supervisor's Name*
68. Supervisor's Title*
69. Employed From: *
70. Employed To: *
72. Average Hours Worked/Week*
73. Reason for looking or leaving?*
74. May we contact this employer?*

    1. Yes
    2. No
76. Employed By: *
77. Your Job Title*
79. Address:
80. City *
81. State*
82. Supervisor's Current Phone
84. Supervisor's Name*
85. Supervisor's Title*
86. Employed From: *
87. Employed To: *
89. Average Hours Worked/Week*
90. Reason for looking or leaving?*
91. May we contact this employer?*

    1. Yes
    2. No
93. Employed by:
94. Your Job Title
96. Address:
97. City
98. State
99. Supervisors Current Phone
101. Supervisor's Name
102. Supervisor's Title
103. Employed From:
104. Employed To:
106. Average Hours Worked/Week
107. Reason for leaving?
108. May we contact this employer?

     1. Yes
     2. No
110. Employed By:
111. Your Job Title
113. Address:
114. City
115. State
116. Supervisors Current Phone
118. Supervisor's Name
119. Supervisor's Title
120. Employed From:
121. Employed To:
123. Average Hours Worked/Week
124. Reason for leaving?
125. May we contact this employer?*

     1. Yes
     2. No
127. Have you worked or attended school under any other names?*

     1. Yes
     2. No
128. If yes, give names: *
130. Are you presently employed?*

     1. Yes
     2. No
131. If yes, whom do you suggest we contact? (Name and phone)*
133. Have you ever been fired or asked to resign from any job?*

     1. Yes
     2. No
134. If yes, please explain briefly:
136. REFERENCES
     Provide three (3) professional references, preferably supervisors from 2-3 most recent positions
138. Name*
139. How known*
140. City State*
141. Email Address/Phone*
143. Name*
144. How known*
145. City State*
146. Email Address/Phone*
148. Name
149. How known
150. City State
151. Email Address/Phone
153. AFFIDAVIT, CONSENT AND RELEASE - PLEASE READ CAREFULLY BEFORE SIGNING
     I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in the application. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre-and/or post-employment drug screen as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE TOWN MANAGER OR TOWN BOARD HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE TOWN MANAGER OR TOWN BOARD AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE. I have read, understand, and by my signature consent to these statements. E-signatures are acceptable if accompanied by a verifiable email from the signer.
155. Signature*
     By typing my name here, I agree to the Affidavit, Consent and Release
156. Date
     Date
158. Attach Resume or additional documents here
160. Attach Letters of Recommendation or additional documents here
162. Attach Letter of Interest or additional documents here
Leave This Blank:


163. 1. Receive an email copy of this form.
164. Email address

     This field is not part of the form submission.

165. Submit Submit and Print

* indicates a required field