b'PRINT MATERIALSAPPLICATION FOR EMPLOYMENT CITY OF AUBURN STATISTICSPLEASE PRINT ALL INFORMATIONThe City of Auburn is an Equal Employment Opportunity Employer. We adhere to a policy of making employment decisions without regard to REQUESTED EXCEPTrace, color religion, sex, national origin, ancestry, sexual preference, SIGNATURE marital status, age or disability or any other legally protected status.PLEASE COMPLETE ALL PAGES 1-4City of Auburn Promotes a Drug & Alcohol Free WorkplaceSelected Economic Characteristics | 2005-2009 Name_____________________________________________________________ Date______________________________ GEOGRAPHIC AREA: AUBURN CITY, INDIANA Present address_______________________________________________________________________________________ Data Set: 2005-2009 American Community Survey 5-Year EstimatesIf less than 3 years, give prior address(s):__________________________________________________________________ Survey: American Community Survey Social Security No. ________-________-_________ For more information on confidentiality protection, samplingTelephone (______)____________________Cell (______)_____________________Email_________________________ error, nonsampling error, and definitions, see SurveyEstimateMargin ofPercentMargin of Error (+/-)Error (+/-)If under 18, please list age___________ Methodology.Selected Economic CharacteristicsPosition(s) applied for (1)_____________________________How many hours can you work weekly?_________________ EMPLOYMENT STATUS Civilian labor force6,31145966.4%3.6Please be specific (2)_____________________________Can you work nights, if job requires? ___________________ Employed5,69944559.9%3.6Salary Desired $_________ Minimum Acceptable $_________Date Available for Work_____________________________ Unemployed6121686.4%1.7 Armed Forces01190.0%0.3 Not in labor force3,20036033.6%3.6Employment Desired[ ] FULL-TIME ONLY[ ] PART-TIME ONLY [ ] FULL/PART-TIME [ ] TEMPORARY[] OTHER OCCUPATION Civilian employed population 16 years and over5,6994455,699(X)EDUCATIONAL BACKGROUND Management, professional, and related occupations1,73528430.4%4.4 Service occupations84917014.9%2.7 Sales and office occupations1,70631329.9%4.7TYPE OF SCHOOLNAME OFLOCATION (CompleteNUMBER OF YEARSMAJOR & DEGREE Farming, fishing, and forestry occupations26330.5%0.6SCHOOLMailing AddressCOMPLETED Construction, extraction, maintenance, and repair occupations83601.5%1.0High School Production, transportation, and material moving occupations1,30024022.8%4.1 INDUSTRYCollege Civilian employed population 16 years and over5,6994455,699(X) Agriculture, forestry, fishing and hunting, and mining23310.4%0.6 Construction190973.3%1.7Bus. Or Trade School Manufacturing1,43525325.2%3.6Professional School Wholesale trade1971263.5%2.2 Retail trade72419712.7%3.5HAVE YOU EVER BEEN CONVICTED OF A FELONY?[] Yes[] NoTransportation and warehousing, and utilities2331024.1%1.8If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were Information1761133.1%1.9committed, sentence(s) imposed, and type(s) of rehabilitation___________________________________________________ Finance and insurance, and real estate and rental and leasing4571898.0%3.2____________________________________________________________________________________________________ Professional, scientific, and management, and administrative and4221567.4%2.8 waste management servicesCOMPLETE THIS SECTION IF THE JOB APPLIED FOR REQUIRES YOU TO DRIVE A CITY VEHICLE Educational services, and health care and social assistance95819416.8%3.1 Arts, entertainment, and recreation, and accommodation and food4421457.8%2.4DO YOU HAVE A DRIVERS LICENSE?[] YES [] NO [] Operator[] Commercial (CDL) [] Chauffeur services Other services, except public administration2381274.2%2.2Drivers license number _______________________________ State of issue_______ Expiration date __________________ Public administration204943.6%1.6 Have you had any motor vehicle accidents during the past three years? [] Yes[] NoIf yes, how many?_______________ Have you had any moving violations during the past three years? [] Yes[] NoIf yes, how many?_______________ CDL DRIVERS PROVIDE YOUR DATE OF BIRTH [FMCS REGS SEC. 391.21]MO_______ DAY_______ YEAR________ CITY OF AUBURN STATISTICSRevised 3/30/11 1 APPLICATION FOR EMPLOYMENTRevised 5/15/12 1CITY OF AUBURN BRAND GUIDELINES27'