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2. City of Ashland
   601 Main Street W
   Ashland, WI 54806
   Phone: 715-682-7071
   Fax: 715-682-7048
   The City of Ashland does not discriminate on the basis or race, color, national origin, sex, gender identity, sexual orientation, religion, age, marital status, family/parental status, political beliefs, or disability in employment or provision of services, programs or activities.
4. Position Applying For
6. First Name
7. Last Name
9. Address
11. City
12. State
13. Zip Code
15. Email Address
16. Home Phone
18. Cell Phone
22. Education
24. High School Name
25. Years Completed
26. Major or Degree
28. College/University
29. Years Completed
30. Major or Degree
32. Technical/Vocational School
33. Years Completed
34. Major or Degree
36. Other
37. Years Completed
38. Major or Degree
42. If hired, can you provide documents required to establish your eligibility to work in the United States?

    1. Yes

    1. No
43. Do you have a valid driver's license?

    1. Yes

    1. No
45. Have you ever been convicted of, or pled guilty or not contest to, a crime other than a minor traffic violation?

    1. Yes

    1. No
47. Please Provide a Brief Explanation
    This information will not necessarily disqualify you from employment but false or misleading information will. Factors such as age and time of offense, seriousness and nature of the violation, and rehabilitation will be taken into account.
51. Previous Employment
    Please list the most recent employer first.
53. Name
55. Address
57. City
58. State
59. Zip Code
61. Phone Number
62. Start of Employment
    Start of Employment
63. End of Employment
    End of Employment
65. Salary
    Starting salary to ending salary.
66. Last Job Title
68. List duties performed, skills used or learned, advancements, or promotions while you worked at this company.
70. Reason for Leaving
    Please be specific.
72. May we contact this employer?

    1. Yes

    1. No
74. Name
76. Address
78. City
79. State
80. Zip Code
82. Phone Number
83. Start of Employment
    Start of Employment
84. End of Employment
    End of Employment
86. Salary
    Starting salary to ending salary.
87. Last Job Title
89. List duties performed, skills used or learned, advancements, or promotions while you worked at this company.
91. Reason for Leaving
    Please be specific.
93. May we contact this employer?

    1. Yes

    1. No
97. References
    Please list two references other than relatives and previous employers.
99. Name
100. Phone
102. Position
103. Company
107. Is there any additional information, applicable to this position, you wish to have considered as part of your application for employment?
109. Do you have any relatives who currently work for the City of Ashland?

     1. Yes
     2. No
110. Name
112. Please read this statement carefully before signing below:
     I understand that employment with the City of Ashland is at-will, meaning that I or the City of Ashland may terminate my employment at any time, or for any reason consistent with applicable union contracts or state and federal law.
     
     I authorize the City of Ashland to conduct a thorough background investigation of my work and personal history, and verify all data given on this application and during interviews. I hereby release the City of Ashland and its representatives or agents, from any liability that might result from such an investigation. I authorize all individuals, schools, and firms named to provide any requested information and release them from all liability for providing the requested information.
     
     I understand the City of Ashland may require the successful completion of a drug and/or alcohol test as a condition of employment.
     
     I understand this application will be active for a period of 90 days; after that time, if I wish to be considered for employment, I must submit a new application. I certify that all the statements in this completed application are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire.
114. Signature
115. Date
     Date
Leave This Blank:


117. 1. Receive an email copy of this form.
118. Email address

     This field is not part of the form submission.

119. Submit

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