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Test Job Application Form
Home
> Test Job Application Form
Job Application - Main (1)
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1
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Application Information
Name
*
First
Middle
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
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Virginia
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
Date Available
*
MM slash DD slash YYYY
What site did you learn about this position?
*
Were you referred to this position by a current City of Pittsburg Employee?
*
Yes
No
If yes, what is the current City of Pittsburg's employee's name?
Employment Desired?
*
Full Time
Part Time
Days/times available to work
*
Mornings
Afternoons
Evenings
Weekends
Hour of work (per week) desired?
*
Are you 18 years of age or older?
*
Yes
No
Enter your age (if younger than 18 years)
*
Are you eligible to work in the United States?
*
Yes
No
Have you ever worked for this organization?
*
Yes
No
Have you ever been convicted of a felony?
*
Yes
No
If yes, please explain:
(Number of conviction(s), nature of offense(s), how recently such offense(s) was/were committed, and sentence(s) imposed)
Education
Where did you attend High School and College? (Please include other relevant education information)
School Name
School Address
Did you graduate?
Degree/Major
Military Service
Military Branch
Rank at Discharge
From
To
Are you currently in the Armed Forces?
Yes
No
Employment History (Most Recent)
Company Name (Most Recent)
Company Address (Most Recent)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Company Phone (Most Recent)
Supervisor (Most Recent)
Your Job Title (Most Recent)
Starting Salary (Most Recent)
Ending Salary (Most Recent)
Responsibilities (Most Recent)
From
To
Reason for Leaving (Most Recent)
May we contact your previous supervisor for a reference? (Most Recent)
Yes
No
Employment History (Second Most Recent)
Company Name (Second Most Recent)
Company Address (Second Most Recent)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
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Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
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India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Supervisor (Second Most Recent)
Company Phone (Second Most Recent)
Your Job Title (Second Most Recent)
Starting Salary (Second Most Recent)
Ending Salary (Second Most Recent)
Responsibilities (Second Most Recent)
From
To
Reason for Leaving (Second Most Recent)
May we contact your previous supervisor for a reference?
Yes
No
References
Please list at least three professional references.
*
Full Name
Relationship
Company
Phone
Address
Resume Upload
Max. file size: 10 MB.
If you have a resume you'd like to attach, please do so here. This is not required.
Cover Letter
Max. file size: 10 MB.
If you have a cover letter you'd like to attach, please do so here. This is not required.
Supplemental Forms (Optional)
Drop files here or
Select files
Accepted file types: jpg, pdf, doc, png, Max. file size: 10 MB, Max. files: 3.
Certain positions require additional forms to be submitted. You may attach them here.
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment. I understand that the company may require me to successfully complete a pre-employment drug and alcohol test as a condition of employment and that continued employment may be based on the successful completion of similar tests. I understand that the company may as part of the hiring process request an investigative consumer report from a third party entity or agency including information concerning my character, general reputation, personal characteristics, credit records, and mode of living. I may make a written request to the company to provide me with additional information regarding the nature and scope of any such report. I understand that employment with your company is “at will” and nothing in the interview or hiring process, this application, or your company policies are intended to create an employment contract between myself and the company. Employment may be terminated by either party at any time for any reason with or without notice.
Digital Signature
*
Printing your First Name + Middle Initial + Last Name will act as your digital signature.
Date
*
MM slash DD slash YYYY
Untitled
First Choice
Second Choice
Third Choice
Untitled
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