City of Durango | Forms | Employment Application


949 E. Second Avenue \| Durango, CO 81301 \| 970.375.5000 \| 970.375.5098 - Fax

Employment Application
EQUAL OPPORTUNITY STATEMENT The City of Durango does not discriminate on the basis of race, color, national origin, gender, religion, age, sexual orientation, or disability in employment or the provision of services. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. Affirmative Action Statistics Form Must Accompany Application Form Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Every applicant must complete this form, along with any submitted resume. If you prefer to create a hard copy form to submit in person or through the mail, please jump to the Adobe Acrobat (PDF) form.
Position(s) applied for:
First Name:
Middle Initial:
Last Name:
Mailing Address:
City:
State:
Zip-Code:
Telephone Numbers:	Home - Work -
Email Address:
How long have you lived at above address?
If hired, can you furnish proof you are eligible to work in the U.S.?	Yes No

Have you ever been convicted of a crime, including misdemeanors?	Yes No
If yes, describe below in full:(A conviction will not necessarily disqualify an applicant for employment.)

Would you work:
Full Time Part Time	Weekends Shifts
Specify days and hours if you want to work only part-time:

Have you ever applied here before?	Yes No
If yes, when and for what position?
Have you been previously employed by us? Yes No
If yes, when and in what capacity:
If your application is considered favorably, what is the earliest date you will be available for work?
List any of your relatives working for the City and their relationship to you:
Why are you applying for this position?
What are your long-range work goals?

List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. NOTE: A job offer may be contingent upon acceptable references from current and former employers.
Previous Employment - Job 1:
Company Name:
Type of Business:
Address:
Name of Supervisor:
Business Phone Number:
Business FAX Number:
Business E-mail:
Employed From:
Employed To:
Last Salary:	/per hour /year
Describe your work in detail:
Reason for leaving:

Previous Employment - Job 2:
Company Name:
Type of Business:
Address:
Name of Supervisor:
Business Phone Number:
Business FAX Number:
Business E-mail:
Employed From:	Year/Month
Employed To:	Year/Month
Last Salary:	/per hour /year
Describe your work in detail:
Reason for leaving:

Previous Employment - Job 3:
Company Name:
Type of Business:
Address:
Name of Supervisor:
Business Phone Number:
Business FAX Number:
Business E-mail:
Employed From:	Year/Month
Employed To:	Year/Month
Last Salary:	/per hour /year
Describe your work in detail:
Reason for leaving:

Previous Employment - Job 4:
Company Name:
Type of Business:
Address:
Name of Supervisor:
Business Phone Number:
Business FAX Number:
Business E-mail:
Employed From:	Year/Month
Employed To:	Year/Month
Last Salary:	/per hour /year
Describe your work in detail:
Reason for leaving:

Previous Employment - Job 5:
Company Name:
Type of Business:
Address:
Name of Supervisor:
Business Phone Number:
Business FAX Number:
Business E-mail:
Employed From:	Year/Month
Employed To:	Year/Month
Last Salary:	/per hour /year
Describe your work in detail:
Reason for leaving:

Military Employment
Did you serve in the U.S. Armed Forces? Yes No If yes, what branch? Number of years served: Rank at Discharge: List duties in the service including special training:

RECORD OF EDUCATION
Name of High School/GED
Address
Course of Study
Check last year completed
Did you graduate?	Yes / No
List Diploma or degree:
Name of College
Address
Course of Study
Check last year completed
Did you graduate?	Yes / No
List Diploma or degree:
Name of Other
Address
Course of Study
Check last year completed
Did you graduate?	Yes / No
List Diploma or degree:
Typing speed (words per minute):

What machines, types of vehicles, office equipment can you operate that relate to the job for which you are applying?
Are there any other experiences, skills, or qualifications which you feel would especially qualify you for work with the City?
Have you worked or attended school under any other names?		Yes No
If yes, give names:
Are you presently employed?		Yes No
May we contact your current employer?		Yes No
If yes, who?
Have you ever been fired or asked to resign from a job?		Yes No
If yes, please explain?

REFERENCES: (Not relatives or supervisors noted in work history.)
1.	Name and Occupation
	Phone:
	Address
2.	Name and Occupation
	Phone:
	Address
3.	Name and Occupation
	Phone:
	Address

Do you currently have a valid driver's license?	Yes No
If so, what is the number:
State Issued:
and Class:
Have you ever had your license revoked or suspended in any state?	Yes No
If yes, give date:
Location:
Length of suspension:
Reason for suspension:
Have you had any accidents during the past three years?	Yes No
If yes, explain each in detail giving date and circumstances:
Have you received any moving violation during the past three years?	Yes No
If yes, explain each in detail giving date and circumstances:
Are you eligible to obtain a CDL license if necessary for the position?	Yes No
This application for employment will remain active for a limited time. Ask the human resources representative for details.



Submit your application only after you have read and understand the following statement. Submitting this application affirms your agreement with this statement.
I am an applicant for the position with the City of Durango, Colorado. The facts set forth in my application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. I understand that a confidential background check may be performed on me, and that appointment to any City position is dependent upon the satisfactory completion of this check. 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 allowed by law and as may be deem necessary to judge my capability to do the work for which I am applying. I release the City to check with any employer, other references listed on this application, schools or colleges, criminal justice records, motor vehicle records or any other resource. I authorize all such resources to answer all questions and provide such information as requested by the City, and I release all such resources from any liability or consequences which may result from providing such information.
I have read and understand the above.

To submit online and print a PDF copy of this form: submit the form first, use your back arrow button, then click on Print Application.

application2008