Your E-Key to the City of Pine Bluff
Apply for City of Pine Bluff Employment Application

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:City of Pine Bluff Employment Application
ID:1
Contact Information
* Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Resume:
Supported formats: Word, PDF, RTF, Text, and HTML.
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Position(s) for which you are applying:
* Position:
Position:
Position:
General Information
Drivers License #:
State:
Expiration Date:
License Class:
Endorsement:
* Have you ever received three (3) or more convictions for moving traffic violations during the last 36 months (3 years)?
Yes
No
* Have you received a Driving While Intoxicated (DWI) or Driving Under Influence (DUI) citation during the last 36 months (3 years)?
Yes
No
* Is your driverís license currently suspended?
Yes
No
* Are you currently employed by the City of Pine Bluff?
Yes
No
If Yes, please indicate your Department/Division:
* Are you a former employee of the City of Pine Bluff?
Yes
No
If Yes, please indicate the Last Date(s) of Employment and Department/Division
* Have you ever been discharged or forced to resign from a position?
Yes
No
If yes, please indicate Employer, Date and Reason.
* Do you have any relatives working for the City of Pine Bluff?
Yes
No
If yes, please indicate Name, Relationship and Department.
* Have you ever been convicted of a
felony?(Excluding those records that
have been expunged, eradicated, sealed,
or disposed of in Juvenile Court).
CONVICTION IS NOT AN AUTOMATIC
BAR TO EMPLOYMENT.
Yes
No
If Yes, please indicate Nature of Offense, Name and Location and Date of Conviction
Elementary and High School
* Highest Grade Completed (Choose
One)
7
8
9
10
11
12
* Did you graduate from High School or obtain a GED?
Yes
No
* Name and Location of last school attended. (High School, Jr. High, etcÖ)
Correspondence, Business, Trades Training
For School/Training 1, please list: Name & Location of School, Dates Attended (To/From), Course/Subjects Completed and Diploma/Certificate Received.
Colleges and Universities Attended
For College/University 1, please indicate: Name & Location of School, Dates Attended (To/From), Type of Degree (BA/BS/MA/PhD), and Major.
Related Licenses
For Professional License 1, please indicate: Organization Issued By, Field/Trade Specialization, License #, Issue Date/Expiration Date.
Additional Skills
Please indicate any additional skills by checking below.
Access
GIS
Drafting
Excel/Lotus
Word/Word Perfect
Power Point
Outlook
Auto Cad
ORACLE
Approach
Typing
If you answered Typing, please indicate your WPM:
Do you have any Other skills that are applicable to this job?
Personal References 1
(Excluding Former Employees and Relatives)
Note: Please complete ALL information on personal references.
* Name:
* Address:
* Telephone:
* Years Known:
Personal References 2
(Excluding Former Employees and Relatives)
Note: Please complete ALL information on personal references.
* Name:
* Address:
* Telephone:
* Years Known:
Personal References 3
(Excluding Former Employees and Relatives)
Note: Please complete ALL information on personal references.
* Name:
* Address:
* Telephone:
* Years Known:
Personal References 4
(Excluding Former Employees and Relatives)
Note: Please complete ALL information on personal references.
* Name:
* Address:
* Telephone:
* Years Known:
Military Service Record
* Have you ever served in the armed forces?
Yes
No
If so what branch?
Air Force,
Army,
Marine Corps,
National Guard,
Navy
What were your duties? (Include Special Training and Duty Station(s))
Have you had any schooling under the G.I. Bill of Rights?
Yes
No
If yes, please describe.
EMPLOYMENT HISTORY
* Can we contact your present employer?
Yes
No
* Starting Date
(MM/YY)
* Ending Date
(MM/YY)
* Employer/Company Name and Address
(City and State Required)
* Work Status:
Full Time,
Part Time,
Volunteer
* Hours Per Week:
* Name and Title of Immediate Supervisor:
* Telephone #
* Fax #
* Starting Salary:
* Ending Salary:
* Reason for Leaving:
Position Held:
* Describe job responsibilities:
EMPLOYMENT HISTORY 2
Starting Date
(MM/YY)
Ending Date
(MM/YY)
Employer/Company Name and Address
(City and State Required)
Work Status:
Full Time,
Part Time,
Volunteer
Hours Per Week:
Name and Title of Immediate Supervisor:
Telephone #
Fax #
Starting Salary:
Ending Salary:
Reason for Leaving:
Position Held:
Describe job responsibilities:
EMPLOYMENT HISTORY 3
Starting Date
(MM/YY)
Ending Date
(MM/YY)
Employer/Company Name and Address
(City and State Required)
Work Status:
Full Time,
Part Time,
Volunteer
Hours Per Week:
Name and Title of Immediate Supervisor:
Telephone #
Fax #
Starting Salary:
Ending Salary:
Reason for Leaving:
Position Held:
Describe job responsibilities:
EMPLOYMENT HISTORY 4
Starting Date
(MM/YY)
Ending Date
(MM/YY)
Employer/Company Name and Address
(City and State Required)
Work Status:
Full Time,
Part Time,
Volunteer
Hours Per Week:
Name and Title of Immediate Supervisor:
Telephone #
Fax #
Starting Salary:
Ending Salary:
Reason for Leaving:
Position Held:
Describe job responsibilities:
EMPLOYMENT HISTORY 5
Starting Date
(MM/YY)
Ending Date
(MM/YY)
Employer/Company Name and Address
(City and State Required)
Work Status:
Full Time,
Part Time,
Volunteer
Hours Per Week:
Name and Title of Immediate Supervisor:
Telephone #
Fax #
Starting Salary:
Ending Salary:
Reason for Leaving:
Position Held:
Describe job responsibilities:
CONSENT FOR CRIMINAL BACKGROUND CHECK
* Last Name:
* First Name:
* Middle:
* City:
* State:
* Zip:
* Social Security Number:
* Driverís License No:
* State Driverís License Issued In:
* Date of Birth:
* Maiden or Other Name(s) Used
Last:
First:
Middle:
I hereby give my permission for the City of Pine Bluff to obtain information relating to
my criminal history through the Pine Bluff Police Department, the District Courts of
Jefferson County, the State and Nation. The criminal history record may include arrest
and conviction data as well as plea bargains and deferred adjudications. I understand
that this information will be used, in part, to determine my employment eligibility with
the City of Pine Bluff.
* Signature of Applicant
* Date
APPLICANT INFO. FOR RECORD KEEPING REQUIREMEMENTS
The City of Pine Bluff is an Equal Opportunity Employer. We ask that you voluntarily provide
the following information which will be used to study recruitment and employment patterns and
to provide, as requested, that statistical data to certain federal compliance agencies. This
information WILL NOT be used in the employment process; and failure to provide the
information WILL NOT jeopardize your opportunity for employment with the City of Pine Bluff.
Date:
Name:
Title of job(s) for which you have applied:
Sex:
Male
Female
Race/Ethnic
Please check the category which identifies your race/ethnic background.
WHITE
AFRICAN AMERICAN
HISPANIC
ASIAN
AMERICAN INDIAN
ALASKAN NATIVE
I understand that I am protected by various laws prohibiting discrimination of the basis of race, color, national origin, sex, religion, age (if over the age of 40) and, in some circumstances, disability, veteran status. I further understand that the information contained in this form is to be used solely in equal employment record keeping, reporting and other legal requirements. I also understand that the information will be kept in the strictest of confidence and will not be disclosed to others except for this above stated purpose and then only if necessary.
Signature of Applicant
Date
NOTE: The information provided on this form will be kept separate from the employment application form.

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