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2. Name*

   Full Legal Name

3. Email Address*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Date of Application Submission*
    Date of Application Submission
13. Date are you available for work?*
    Date are you available for work?
14. Are you legally eligible for employment in this country?*

    1. Yes
    2. No

    (proof of U.S. citizenship or immigration status will be required upon employment)

18. Position Applying For (​Click All That Apply)*

    1. Aquatic Center- Manager
    2. Aquatic Center- Crew Leader
    3. Aquatic Center- Head Guard
    4. Aquatic Center- Lifeguard
    5. Aquatic Center- Admissions

    1. Aquatic Center- Concession Manager
    2. Aquatic Center- Concession
    3. Concessions Softball- Manager
    4. Concessions Softball- Attendant
    5. Softball Umpire

    1. Summer Camp- Asst. Camp Director
    2. Summer Camp- Camp Counselor
    3. Park Operations- Seasonal Maintenance
    4. Park Operations- Weekend Laborer

    • Must be 18 years or older to apply for manager positions
    • Must be 15 years or older to apply for lifeguard
    • Must be 15 years or older to apply for  concession and admission positions.
20. If offered any of the jobs you are applying for, what would be your first preference to be considered for)*
    -- Select One --Aquatic Center-ManagerAquatic Center- Crew LeaderAquatic Center-Head GuardAquatic Center-Life GuardAquatic Center-AdmissionsAquatic Center-Concession ManagerAquatic Center-ConcessionConcessions Softball-ManagerConcessions Softball-AttendantSoftball UmpireSummer Camp-Assistant Camp DirectorSummer Camp-Camp CounselorPark Operations-Seasonal MaintenanceParks Operations-Weekend Laborer
21. Second Preference
    -- Select One --Aquatic Center-ManagerAquatic Center-Crew LeaderAquatic Center-Head GuardAquatic Center-LifeguardAquatic Center-AdmissionsAquatic Center-Concession managerAquatic Center-ConcessionConcessions Softball-ManagerConcessions Softball-AttendantSoftball UmpireSummer Camp-Assistant Camp DirectorSummer Camp-Camp CounselorPark Operations-Seasonal MaintenancePark Operations-Weekend Laborer
22. Third Preference
    -- Select One --Aquatic Center-ManagerAquatic Center-Crew LeaderAquatic Center-Head GuardAquatic Center-LifeguardAquatic Center-AdmissionsAquatic Center-Concession ManagerAquatic Center-ConcessionConcessions Softball-ManagerConcessions Softball-AttendantSoftball UmpireSummer Camp-Assistant Camp DirectorSummer Camp-Camp CounselorPark Operations-Seasonal MaintenancePark Operations-Weekend Laborer
26. Education
28. High School:*

    or High School Equivalency Diploma (GED)

29. High School Address:*
30. Dates Attended:*
    Dates Attended: Start Date

    —

    Dates Attended: End Date
32. College Name:

    (if applicable)

33. College Address:

    (if applicable)

34. Dates Attended:
    Dates Attended: Start Date

    —

    Dates Attended: End Date

    (if applicable)

36. Technical School:

    (if applicable)

37. Technical School Address:

    (if applicable)

38. Dates Attended:
    Dates Attended: Start Date

    —

    Dates Attended: End Date

    (if applicable)

40. List special skills or qualifications:
42. List any job related volunteer work, hobbies, or memberships:
44. Have you worked for the City of Shelbyville before?*

    1. Yes
    2. No
45. If so, in what position(s):
47. Are you able to meet the attendance requirement of the position?*

    1. Yes
    2. No
48. Have you been convicted of a felony in the last seven (7) years?*

    1. Yes
    2. No
49. If yes, please explain:

    (such conviction may be relevant if job related, but does not bar you from employment.)

51. Drivers License # & State*

    or State Issued ID #

52. For lifeguard applicants only: Are you certified?

    1. Yes
    2. No
53. When does your certification expire?
55. Upload a copy of Lifeguard Certifications

    If applicable

59. Employment History

    List most recent or present place of employment

61. Employer #1
62. Address
64. Phone Number
65. Hourly Wage/Salary
66. Dates Employed
    Dates Employed Start Date

    —

    Dates Employed End Date
68. Position(s) Held
69. Name of Supervisor
70. May we contact employer?

    1. Yes
    2. No
72. Employer #2
73. Address
75. Phone Number
76. Hourly Wage/Salary
77. Dates Employed
    Dates Employed Start Date

    —

    Dates Employed End Date
81. References

    Please list two references other than relatives or previous employers

83. Name*

    First and Last Name

84. Phone Number*
85. Address*
87. Name*
88. Phone Number*
89. Address*
93. Resume Upload
97. Electronic Signature Agreement*

    I certify that all the above information contained in this application is correct to the best of my knowledge.  I agree that any misrepresentation or omission of facts is reason for dismissal.  I further authorize the City of Shelbyville, its agents and employees, considering my request for employment, to conduct a criminal record and background check through any resources available to the City of Shelbyville.  I hereby release and indemnify the City of Shelbyville its agents and employees and the persons, businesses, or agencies from whom the information is requested, of liability of any kind or nature of responsibility for any damages that at any time may occur from conducting a criminal record or background search of the employee or applicant.  This release of all liability and responsibility includes, but is not limited to, all discussions with past or present employers, friends, criminal record check, credit checks and license checks.

    Furthermore, should I become employed (or re-employed); this release of liability and responsibility shall remain valid, for periodic re-checks during my employment with the City of Shelbyville.

    Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law.  I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice.  I understand that no representative of the Employer has the authority to make any assurances to the contrary.

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
99. Electronic Signature*
Leave This Blank:


103. 1. Receive an email copy of this form.
104. Email address

     This field is not part of the form submission.

105. Submit

* indicates a required field