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W:\W DOX\10116101\7344.DOC / 10/31/2013 Revised: 10/31/2013
City of Wilmington
FOR HUMAN RESOURCES USE ONLY
Please Type or Print Clearly
POSITION DESI RED:
SOCIAL SECURITY NO.
(Last) (First) (MI)
(Street) (City) (State) (Zip Code)
Work: Cell: Email:
May we call you at work?
IN CASE OF EMERGENCY NOTIFY:
Can you, after em ployment, submit verification of y our legal right to work in the United States?
Have you applied for this position within the last six months?
Yes No Check the Type( s ) of Employm ent: Regular Part-Time Seasonal
Education Intern Temporary
Have you ever been employed by the City?
Yes No If yes, when:
If under age 18, can y ou furnish a work permit?
Yes No If no, explain:
If a license or certificate is a requirement of this position, give the following information:
State: _______________________ Class:
Driver’s License Nu mber:
Languages other than E nglish spoken:
CHECK HIGHEST GRADE COMPLETED:
1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7
DO YOU HAVE A HIGH SCHOOL EQUIVALENCY CERTIFICATE (GED)?
NAME AND LOCATION
Month & Year
(Transc ripts may
be require d)
An Equal Opportunity Employer