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Employment Application

2. 
3. Application For Employment
   City of Liberty Lake, 22710 E Country Vista Dr., Liberty Lake, WA 99019
5. PERSONAL INFORMATION
7. First Name*
8. Last Name*
10. Address1*
12. City*
13. State*
14. Zip*
16. Phone Number*
17. Email Address
19. Are you legally eligible to work in the US? *

    1. Yes

    1. No
20. Are you a veteran?

    1. Yes

    1. No
22. If selected for employment, the City of Liberty Lake will complete a background check.
26. POSITION
28. Position you are applying for*
29. Available start date
31. Employment desired

    1. Full time

    1. Part time

    1. Seasonal/ Temporary
35. EDUCATION
37. School name
38. Location
39. Degree Received
40. Major
42. School name
43. Location
44. Degree Received
45. Major
47. High School Attended
48. Location
49. Diploma received
50. Years attended
54. REFERENCES
56. Name
57. Title
58. Company
59. Phone
61. Name
62. Title
63. Company
64. Phone
66. Name
67. Title
68. Company
69. Phone
73. Employment History
75. Employer (1)
76. Job title
77. Dates employed
79. Address
80. Work phone
82. City
83. State
84. Zip
86. Employer (2)
87. Job title
88. Dates employed
90. Address
91. Work phone
93. City
94. State
95. Zip
97. Employer (3)
98. Job title
99. Dates employed
101. Address
102. Work phone
104. City
105. State
106. Zip
108. Employer (4)
109. Job title
110. Dates employed
112. Address
113. Work phone
115. City
116. State
117. Zip
121. SIGNATURE DISCLAIMER
     I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my employment being terminated.
122. Date
Leave This Blank:


124. 1. Receive an email copy of this form.
125. Email address

     This field is not part of the form submission.

126. Submit

* indicates a required field