The City of Lindsborg is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability or national origin. Consistent with the Americans with Disabilities Act, applicants may request accomodations needed to participate in the application process.

Please complete, print and sign the application form below and mail to attention of Human Resources, City of Lindsborg, P.O. Box 70, Lindsborg, Kansas 67456-0070.

PERSONAL INFORMATION

Social Security Number:*

Full Name (Last, First, Middle Initial):*

Address (Street, City, State, Zipcode):*

Phone Number 1:*

Phone Number 2:

Email Address:

How did you hear about this position?:*

Are you 18 years of age or older?:*

Yes

No

EMPLOYMENT DESIRED

Position:*

Date You Can Start:*

Salary Desired:

Are You Currently Employed?:*

Yes

No

If So May We Inquire of Your Present Employer?:*

Yes

No

Ever Applied to the City of Lindsborg Before?:*

Yes

No

EDUCATION

Grammar School:
(Name, Location, Last Year Completed)

Graduated:*

Yes

No

High School:
(Name, Location, Last Year Completed)

Graduated:*

Yes

No

College:
(Name, Location, Last Year Completed, Degree)

Graduated:*

Yes

No

Trade, Business or Correspondence School:
(Name, Location, Last Year Completed, Degree)

Graduated:*

Yes

No

GENERAL

Subjects of Special Study, Research Work or Certifications:

Job Related Skills (Computer, Driver's License, etc):*

FORMER EMPLOYERS

List your last four employers starting with the most recent first. Include Name,
Address of Employer, Start & End Dates, Salary (upon leaving), Position and
Reason for Leaving.

Employer 1:

Employer 2:

Employer 3:

Employer 4:

REFERENCES

List three persons not related to you, whom you have known at least one year.
Include Name, Address, Position and Years Aquainted.

Reference 1:

Reference 2:

Reference 3:

AUTHORIZATION

I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the City of Lindsborg.

I understand that any employment is conditioned on a background check. I authorize the City of Lindsborg to thoroughly investigate all statements contained in my applicaiton or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the City of Lindsborg, without giving me prior notice of such disclosure. In addition, I release the City of Lindsborg, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation of disclosure.

I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be "at will" and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the City of Lindsborg. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the City of Lindsborg unless made in writing.

If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the City of Lindsborg and as permitted by law. I consent to such examiniations and tests, and I request that the examining doctor disclose to the City of Lindsborg the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by the City of Lindsborg Drug and Alcohol Policy.

I understand that filling out this form does not indicate there is a position open and does not obligate the City of Lindsborg to hire. If hired, I agree to abide by all City of Lindsborg work rules, policies, and procedures. The City of Lindsborg retains the right to revise its policies or procedures, in whole or in part, at any time.

Signature of Applicant:*

Date:*