141 W. Haynes St | Sandersville, GA 31082 | 478-552-2525

Application for Employment

Date: Position Applied for:

Personal Data:

Full Name:
First
Middle
Last
Mailing Address:
Street
 
City
State
Zip
E-mail address:
Phone:
Home
Work
Cell

How did you hear about this opening? Salary Requirement:
Which will you accept:
*Check all that apply) 		Full Time? Part Time? Seasonal? Shift work?
Are you over 18 years old? Yes No
Are you eligible to work in the United States? Yes No
(either because you are a U.S. Citizen or have U.S. government permission to do so)

NOTE: If offered employment you will be required to provide documentation to verify employment eligibility. Failure to provide the requested documentation may result in a determination that the applicant is ineligible for employment in the United States.

Have you ever worked for us before? Yes No If yes, When & Where?

Give name, relationship and department of any relatives employed by the City of Sandersville:

Driver's History Information:

Do you have a valid Driver's License: Yes No Class: State:
Have you received any traffic violations in the past 5 years? Yes No If yes, list type of offense and dates:

Criminal History Information:

Have you (since the age of 18) ever been convicted of or plead guilty or no contest to a misdemeanor? (For example: DUI, Bad Checks, etc) Yes No (Omit non-moving traffic violations/parking tickets and any offense which was finally adjudicated in a Juvenile Court or under a Youth Offender Law)

If YES describe the circumstances. (Date, Place, Charges, Disposition).

Have you (since the age of 18) ever been convicted of or plead guilty or no contest to a felony? Yes No

If Yes, describe the circumstances: (Date, Place, Charges, Disposition)

NOTE: Applicants convicted of a criminal offense involving the manufacture, distribution, trafficking, or sale of a controlled substance, dangerous drugs or marijuana, or convicted of any felony involving a violent crime such as assault with a deadly weapon, aggravated assault or murder are ineligible to be employed with the City of Sandersville. Such applicants will automatically be rejected. Applicants convicted of any other felony shall be considered on a case by case basis. An applicant convicted of a felony or misdemeanor who has received a pardon from the appropriate State Pardons and Parole Board shall be eligible for employment with the City of Sandersville.

Have you ever been suspended, demoted, dismissed or asked to resign from any job?
Yes No If Yes, explain in detail

Education:

High School

Name Address
(Name of the high school of state authority issuing the diploma or certificate)
Check highest grade completed: 7th 8th 9th 10th 11th 12th
Graduated? Yes No If no, do you have GED? Yes No

Colleges/Universities

Please complete the following for post-secondary education (Technical Schools/Colleges/Universities):

Name of School City/State No. of Hours Degree Type Earned
Yes No
Yes No
Yes No

Skills/Training

Describe specialized training, qualifications, apprenticeship, skills and extra-curricular activities which relate to the position for which you are applying. Include office equipment, computer skills, foreign language skills, typing skills, and business equipment or machine operating skills which may relate to the position for which you are applying.

References:

Give names, addresses, and telephone numbers of three (3) references that ARE NOT related to you and ARE NOT previous employers.

Name: Phone:
Street Address:
City, State, Zip:
Name: Phone:
Street Address:
City, State, Zip:
Name: Phone:
Street Address:
City, State, Zip:
Name: Phone:
Street Address:
City, State, Zip:

Employment History:

Describe your work history beginning with your current or most recent job. Include military and volunteer experience and periods of unemployment. Failure to give complete information regarding each job held may result in your disqualification. Complete addresses with zip codes and telephone numbers for all employers are necessary. A resume may be attached only as additional information and will not be accepted in lieu of completing this section.
Name of Organization or Firm: Phone Number:
Address:
1234 Green St., Ste 101
Sandersville, GA 31082

Street

City
State
Zip
Dates of Employment:
from month/year

to month/year
Name of your supervisor: Pay Start
Your official job title: Pay End
Specific Reason for Leaving:
Describe Your Specific Job Duties:
Name of Organization or Firm: Phone Number:
Address:
1234 Green St., Ste 101
Sandersville, GA 31082

Street

City
State
Zip
Dates of Employment:
from month/year

to month/year
Name of your supervisor: Pay Start
Your official job title: Pay End
Specific Reason for Leaving:
Describe Your Specific Job Duties:
Name of Organization or Firm: Phone Number:
Address:
1234 Green St., Ste 101
Sandersville, GA 31082

Street

City
State
Zip
Dates of Employment:
from month/year

to month/year
Name of your supervisor: Pay Start
Your official job title: Pay End
Specific Reason for Leaving:
Describe Your Specific Job Duties:
Name of Organization or Firm: Phone Number:
Address:
1234 Green St., Ste 101
Sandersville, GA 31082

Street

City
State
Zip
Dates of Employment:
from month/year

to month/year
Name of your supervisor: Pay Start
Your official job title: Pay End
Specific Reason for Leaving:
Describe Your Specific Job Duties:
Please use this space for additional information pertinent to your education, training and experience:

Authorization to Release Information

Conditions of Employment

I have made application for employment with the City of Sandersville. I authorize any persons or organizations to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, whether or not it is in their records, with regard to any of the subjects covered by this application, and I release all such parties from all liability for any damage whatsoever for issuing same.

Furthermore, if I am employed by the City of Sandersville, I agree to the policies, rules, orders and regulations of the government set forth in the City of Sandersville‘s Personnel system, employee handbook, policies and procedures and ordinances; and acknowledge that these policies and procedures, rules, and regulations may be changed, interpreted, withdrawn, or added to by the City of Sandersville at any time, at the City’s sole option.

I further acknowledge that if I become employed with the City of Sandersville, my employment will be at -will and may be terminated with or without cause at any time by me or the City of Sandersville until such time that I am no longer on my initial trial period, and become a regular status employee.

If required by the City of Sandersville for the position which I am applying, I consent to undergo a drug test, a physical examination, and/or a psychological examination after I have received a conditional offer of employment, as deemed necessary.

THIS APPLICATION WILL REMAIN ACTIVE FOR NINETY (90) DAYS ONLY.

Should you become an employee with the City of Sandersville, your position may require random drug testing.

May we contact your present employer? Yes No Not presently employed

By checking this box you are agreeing to this authorization to contact prior employers. You must check this box even though if you have chosen for us not to contact your present employer.

Alcohol and Controlled Substance Testing

As a condition of employment with the City of Sandersville, you may be required to submit to an alcohol and controlled substance test. Employees who test positive for illegal drugs and/or alcohol will be terminated. Employees must report any conviction under a criminal drug statute for such violations. A report of the conviction must be made within five (5) days after the conviction.

By checking this box, I acknowledge the above and consent to such an examination and test.

Applicant’s Certification and Agreement

I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I am aware that the falsification of this application or the omission of complete information will result in disqualification, or upon discovery, termination of employment. The City of Sandersville is hereby authorized to make any investigation of my prior educational and work history. Finally, I agree that all records generated for purposes of employment are property of and shall remain the sole and exclusive property of the City of Sandersville.

By checking this box, I acknowledge the above and agree to these terms.

Resumes, letters of reference, etc. submitted with the application become property of the City of Sandersville and will not be returned. The information you have provided on the application is subject to public disclosure under the Georgia Open Records Act.

Applicant’s Certification of Employment Eligibility

I certify that I am in compliance with O.C.G.A. 13-10-91 and that I am a citizen, legal permanent resident or a qualified alien or nonimmigrant and I am eligible to work in the United States.

By checking this box, I acknowledge the above and agree to these terms.
Attach Resume to Email: (pdf only)

Sandersville Facts

Great Location

Sandersville is centrally located between Macon and Augusta, and Atlanta and Savannah. Historic treasures and beautiful scenery make Sandersville a wonderful place to visit or call home.

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Great Weather

The climate here is pleasant and consistently mild, with all the benefits typical of a southern climate.

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Great Service

The City of Sandersville provides an array of services, including water, electricity, high speed internet and a fiber network, at affordable prices.

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SANDERSVILLE local weather

FREE COVID TESTING INFORMATION

Free COVID-19 testing is offered twice weekly in Sandersville -- Monday and Thursday from 8 a.m. until noon. For screening for testing through the North Central Health District, you must contact the COVID-19 testing number 844-987-0099 to get a referral for testing. The health district also offers testing on different days in each county in the district (see schedule here).