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Job Application

  1. Please provide your email address.

  2. Do you have a valid Kansas driver's license?

  3. Do you have a valid Kansas commercial driver’s license (CDL)?

  4. Please be specific and do not respond "any".

  5. Type of position:

  6. Education

  7. If you did not complete high school and the job description requires it, do you have a GED?

  8. Have you ever been employed by the City of Independence?

  9. Have you ever worked under a different name?

  10. Do you have any relatives working for the City of Independence?

  11. Have you ever been convicted of a felony?

  12. Employment History

  13. Would you object to having any of the above employers contacted in regard to your work experience?

  14. Are you presently employed?

  15. Have you ever been a members of the Kansas Public Employees Retirement System, Firemen's System or the Kansas School Retirement System?

  16. Are you currently a member of a military reserve organization?

  17. References

  18. Give name, address, and phone number of three persons who have known you at least one year.

  19. IN CASE OF EMERGENCY, NOTIFY:

  20. I HEREBY CERTIFY THAT THE INFORMATION GIVEN IN THIS APPLICATION IS TRUE AND CORRECT. I UNDERSTAND THAT THE CITY OF INDEPENDENCE, KS MAY RESEARCH ALL STATEMENTS AND CLAIMS MADE ON THIS APPLICATION AND MAKE REFERENCE CHECKS. IF RESEARCH SHOWS THAT FALSE INFORMATION WAS WILLFULLY GIVEN BY ME, IT SHALL BE CONSIDERED SUFFICIENT CAUSE FOR REJECTION OR DISMISSAL.

  21. Please type your First and Last Name

  22. OFFICIAL USE ONLY

  23. Leave This Blank:

  24. This field is not part of the form submission.