Application for Seasonal Employment The City of Chesterfield is an Equal Opportunity Employer. We do not discriminate in employment based on race, color, religion, gender, pregnancy, sexual orientation, gender identity, age, national origin, ancestry, citizenship status, disability (physical or mental), genetic information, military service, or another non-merit factor. These protections extend to all management practices and decisions, including recruitment and hiring practices, appraisal systems, promotions, training, and career development programs. Position(s) Applied For Note: Employment for the Lifeguard position is conditional upon passing the Lifeguard training. Name First Name MI Last Address Street Apt, floor, suite, etc. City State Zip Phone E-mail Parent Cell Parent Email Date Available From Date Available To Can you work at least 19 hours a week during the dates you are availables for hire? * Yes No Do you have a relative working for the City of Chesterfield? * Yes No If yes, what is their name? Have you worked for the City of Chesterfield before? * Yes No The City will make a good faith effort to provide reasonable accommodation to an otherwise qualified candidate who applies for a position or employee who can perform the essential job duties unless such accommodation would impose an undue hardship on the operation of the City. Applicants requiring disability-related accommodations should request them in advance. To the best of your knowledge, would you be able to perform all the essential functions of this position with or without reasonable accommodations? * Yes No Are you legally eligible to be employed in the United States? * Yes No (Proof of identity and eligibility will be required upon employment) Are you of age 16 or older? * Yes No (If no, you will be required to provide authorization to work) Can you work Days? * Yes No Can you work Nights? * Yes No Can you work Weekends? * Yes No Are there any days, hours, or shifts that you cannot work? Please list any scheduled time off you need for vacations, college visits, or other commitments? Please Check Highest Level Achieved * High School / GED Associate's Degree Bachelor's Degree Master's Degree or Above High School Address Did you graduate? --SELECT--YesNo College / University Address Did you graduate? --SELECT--YesNo Degree or Certificate Other Address Did you graduate? --SELECT--YesNo Degree or Certificate Employment History Is this your first Job? --SELECT--YesNo Company Phone Address Supervisor Job Title Date Employed From Date Employed To Reason for Leaving Describe work performed How did you hear about the position? I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. SIGNATURE OF APPLICANT DATE The signing of this application authorizes the City of Chesterfield to conduct a verification and/or screening of any criminal history. You agree to forever release and discharge the City of Chesterfield, to the full extent permitted by law from any claims, expenses, or any charge or complaint filed with any agency arising from the retrieving and reporting of this information.