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Contact Information

First Name*
Last Name*
Position Applying For:*
If you require assistance with the recruitment process due to a disability, please notify our staff at trapier@riverdalega.gov or dledee@riverdalega.gov.
Primary Contact Number*
Driver's License*
1. Yes
2. No
Do you have a valid license?
How Did you Learn About the Position for Which You are Applying?*
If Other, Please Specify
Present Home Address or Mailing Address*
Address2
City*
State*
Zip*
Previous Home Address*
Address2
City
State
Zip
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Education

Employment History

Employment History
List all jobs held in the last Ten Years and any other jobs relevant to the position for which you are applying. Start with your present or most recent position.
Upload your resume
Employer 1 (Present or Most Recent Job)
Employer Name*
From Date*
To Date*
Job Title *
Starting Salary*
Current Salary*
Address
Telephone Number
Supervisor's Name, Title and Phone Number*
Reason for Leaving*
Description of Duties
Employer 2
Employer Name*
From - Date*
To - Date*
Job Title*
Starting Salary*
Current Salary*
Address
Phone Number
Supervisor's Name, Title and Phone Number*
Reason for Leaving*
Description of Duties
Employer 3
Employer Name*
From - Date*
To - Date*
Job Title*
Starting Salary*
Current Salary*
Address
Phone Number
Supervisor's Name, Title and Phone Number*
Reason for Leaving*
Description of Duties
List Any Relevant Volunteer Work And All Periods Of Unemployment Exceeding 90 Days
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Additional Information

List Current Membership(s) in Professional, Job-Related Organizations
List Awards, Commendations, or Other Recognition
List Any Active Professional, Technical and Occupational Licenses or Certifications You Now Hold
List Below Additional Skills (i.e. Software, Hardware, Office and/or Equipment) and Number of Months/Years
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Supplemental Questions

Have You Ever Worked For The City of Riverdale?
1. Yes
1. No
If Yes, Please Provide Date(s) Of Employment
Are You Related to a City Employee or is a Member of Your Household Employed by The City of Riverdale?*
1. Yes
1. No
If Yes, Please Give the Person's Name
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Sign and Date

IMPORTANT
Employment is subject to verification of an applicant's background. Persons selected for employment must (1) present a valid social security card, (2) subsequent to an offer of employment, pass a medical examination by a physician. The medical examination may include testing for the current use of drugs and/or controlled substances. Additionally, the City is required by Federal Law to verify having seen documents, which the applicant must provide as part of the employment processing that show the applicant's identity and right to work in the United State.
APPLICANT: PLEASE READ THIS STATEMENT CAREFULLY BEFORE SIGNING BELOW
I hereby certify that each response on this application and all other information I have furnished in applying for employment with the City of Riverdale is true and correct. I understand that if I am selected for an interview, I will be required to confirm the authenticity of this application by signing the application. I understand that any incorrect, incomplete, or false statement or information I have furnished may subject me to disqualification in an examination or to discharge at any time. After an offer of employment, I give my voluntary consent to be medically examined and to provide a sample of my blood or urine which may be tested for the recent use of drugs and/or controlled substances. Further, I release the City, its officers, agents, and employees from any liability whatsoever in connection with such a medical examination or the use of the test results therefrom.
Name of Applicant
Date

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