Application for Employment

London careers Recruitment Agency

Northcliff House,
2 Derry Street,
London
W8 5TT

POSITION FOR WHICH For C-P Employees Only:

YOU ARE APPLYING: Transfer Reemploy
Check all that you may be interested in: Full-Time Part-time Job-Share:
Last Name First Name Middle Initial

Mailing Address City Parish

State Zip Cell Telephone No. Home Telephone No. Business Phone No. E-Mail Address

Driver’s License # State Expiration Date Operators (Private Vehicle) License Class

CDL (copy needed of Endorsement

license & medical card)
Are you claiming Veteran’s Preference? (Attach a copy of D214 and/or service connected disability) Yes No
Have you ever been convicted of a felony since your 18th birthday? If you answered yes, please complete the (Inaccurate information
following: (Conviction is not an automatic bar to employment. Each case is considered on its individual merits). here will result in
Nature of Offense Name & Location of Court Date of Conviction disqualification.)
Yes No
Are any of your educational or employment records found under a different last name? If yes, please give the last
name. Previous Last Name Yes No

Are you currently employed in United Kingdom? If yes, please give:

Department/Division Yes No

Are you a former employee in United Kingdom? If yes please give:

Last Date(s) of Employment Department / Division Yes No

Have you ever been discharged or forced to resign from any position? If yes, please give employer, date and
reason. Employer Date and Reason Yes No

Do you have any relatives working in United Kingdom? If yes, please complete the following:
(Continue listing relatives on a separate page if necessary)
Name Relationship Department Yes No

If hired, are you authorized to work in United Kingdom? For non citizens, a copy of your authorization to work
issued by the United Kingdom. Immigration and Naturalization Service must be submitted prior to appointment.
Yes No

Do you now hold or are you a candidate for an elective public office? Yes No
References For Office Use Only:
Date and Time Received
Name Telephone Number
 EDUCATION AND TRAINING
ELEMENTARY AND HIGH SCHOOL EDUCATION
Highest Grade Completed (choose one) Did you graduate from High School or obtain Name and Location of Last School Attended
a GED? (High School, Junior High or Elementary)
1 2 3 4 5 6 Name:
YES NO
7 8 9 10 11 12 Location:

Indicate the number of courses completed in each subject: algebra biology bookkeeping

calculus geometry trigonometry

RELATED SPECIAL TRAINING (CORRESPONDENCE, BUSINESS, TRADES, VOCATIONAL, ARMED FORCES SCHOOLS, ETC.)
Dates Attended
Credit Diplomas/Certificates
Names and Locations of School (Mo & Yr) Courses/Subjects Completed
Hours Received
From To

COLLEGES AND UNIVERSITIES ATTENDED (UNDERGRADUATE & GRADUATE)

**Must be from a recognized accredited school - Bring original transcript with initial application**
Dates Attended Type of Degree
Credit Hours
Names and Locations of School(s) (Mo & Yr) Earned Major Minor
From To Semester OR Quarter (e.g.BA/BS)

Major Undergraduate Credit Hours Major Graduate Credit Hours

College Subjects College Subjects
Semester OR Quarter Semester OR Quarter

RELATED LICENSES (provide current original)

Issue Expiration
Professional License Issued By Field/Trade Specialization License Number
Date Date

SKILLS
Access Hansen Drafting Excel/Lotus Other software Languages spoken and
written FLUENTLY
ORACLE GIS Auto Cad Word/WordPerfect

Approach Typing wpm PowerPoint

 Also include specific software experience in your job descriptions.
Ask about PC skills exams and provide certificates of courses completed.

EMPLOYMENT HISTORY

May we contact your present employer? YES NO

Starting Date Ending Date Employer/Company Name and address (city and state are required)
month / day / year
1 month / day / year

Hours per Week Name & Title of Immediate Supervisor Telephone Number
Paid Work Volunteer

Reason for Leaving

Title of Position Held Number & Job Title of Employees you Supervised

Describe job responsibilities in order of importance:

Starting Date Ending Date Employer/Company Name and address (city and state are required)
month / day / year month / day / year
2
Hours per Week Name & Title of Immediate Supervisor Telephone Number
Paid Work Volunteer

Reason for Leaving

Title of Position Held Number & Job Title of Employees you Supervised

Describe job responsibilities in order of importance:

 Starting Date Ending Date Employer/Company Name and address (city and state are required)
month / day / year month / day / year
3
Hours per Week Name & Title of Immediate Supervisor Telephone Number
Paid Work Volunteer

Reason for Leaving

Title of Position Held Number & Job Title of Employees you Supervised

Describe job responsibilities in order of importance:

Starting Date Ending Date Employer/Company Name and address (city and state are required)
month / day / year month / day / year
4
Hours per Week Name & Title of Immediate Supervisor Telephone Number
Paid Work Volunteer

Reason for Leaving

Title of Position Held Number & Job Title of Employees you Supervised

Describe job responsibilities in order of importance:

 Starting Date Ending Date Employer/Company Name and address (city and state are required)
month / day / year month / day / year
5
Hours per Week Name & Title of Immediate Supervisor Telephone Number
Paid Work Volunteer

Reason for Leaving

Title of Position Held Number & Job Title of Employees you Supervised

Describe job responsibilities in order of importance:

Starting Date Ending Date Employer/Company Name and address (city and state are required)
month / day / year month / day / year
6
Hours per Week Name & Title of Immediate Supervisor Telephone Number
Paid Work Volunteer

Reason for Leaving

Title of Position Held Number & Job Title of Employees you Supervised

Describe job responsibilities in order of importance:

APPLICANT DATA
The information requested in the following questions will not affect you as an applicant. This information will be used to determine if our
recruitment efforts are reaching all segments of the community, and to conduct background checks.
Last Name First Name Middle Initial

Social Security Number (required) Date of Month Date Year

Birth Female Male
(Req’d)
Ethnic Origin Race
Hispanic Non-Hispanic African/ Asian Middle East/ South American
or or
Latino Non-Latino Asian Black White
Please indicate how you learned about this job:
Media Job Posting Organizations Other
The Baton Rouge Advocate City job line High school I’m a City employee

Trades Journal Weekly job announcement Vocational/Trade School Referred by City employee
Which one? Which one?

Radio Continuous recruitment list College Walk-in

Which station? Which one?

Television City bulletin board Minority referral source Job Fair:

Which station? Where? Which one?

Web site Other: Job Service Other:

Which one?

Other: Other:

LONDON CAREERS RECRUITMENT AGENCY USE ONLY

HR Signatures [ ] [ ] Computer Doc

Records/Documents review copy type print
Application complete
Open OP Equipment EQ
Promotional PR Admit Written Exam required?
Name (retest flag?) NA
Reemployment RE Stamp and initial
Status (Dem/Lat) DL DNA
DL & SS card ED
Transfer TR Education VT
Veteran CE
Certification SK
Skills CO
Continuing Ed HI
Do not admit for the following reason(s):
Empl History (employees) PA
Payroll Master
(employees)

NS EI WI Passed:
IL DH
Entry Clerical Advanced
NR NE IS Professional
SM ED Clerical
Financial
LC IN FP Other _____________________
RE DS
Maintenance
Date [ ] Score [ ]
SR OR PO
CI AG
Comments:
LI

Job Code:
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