City of Marquette

102 North Street, PO Box 7, Marquette Iowa 52158

(563) 873-3735

APPLICATION FOR EMPLOYMENT

(PRE-EMPLOYMENT QUESTIONAIRE) (AN EQUAL OPPORTUNITY EMPLOYER)

PERSONAL INFORMATION

DATE

NAME

LAST	FIRST	MIDDLE

ADDRESS

NUMBER/PO BOX	STREET	CITY/STATE/ ZIP

TELEPHONE (	)

ARE YOU 18 YEARS OR OLDER	_____NO _____	YES

Iowa law requires that a preference in public employment be given to individuals who qualify as "veterans".

A veteran must be given a preference in hiring over other job applicants who are not better qualified for the position. The questions below must be completed to determine if you are qualified for the veteran's preference.

ARE YOU A "VETERAN" AS DEFINED IN IOWA CODE SECTION 35.1 (SEE ATTACHED COPY) YES ______ NO_____

IF "YES" YOU MUST INCLUDE A DD214 FORM.

OTHER/ADDITIONAL INFORMATION: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

EMPLOYMENT DESIRED

POSITION APPLIED FOR______________________________

DATE YOU CAN START:	DESIRED SALARY:

IF SO, MAY WE INQUIRE

ARE YOU EMPLOYED NOW?	OF YOUR PRESENT EMPLOYER?	_____________

HAVE YOU EVER APPLIED HERE BEFORE?	WHERE?	____________	WHEN?_________	________

REFERRAL SOURCE:

( ) ADVERTISEMENT	( ) WALK IN	( ) EMPLOYMENT AGENCY	( ) RELATIVE	( ) FRIEND	( ) OTHER

EDUCATION	NAME AND LOCATION OF SCHOOL	*NO. OF YEARS ATTENDED	*DID YOU GRADUATE?	SUBJECTS STUDIED
GRAMMAR SCHOOL
HIGH SCHOOL
COLLEGE/ UNIVERSITY
TRADE, BUSINESS, SPECIALITY EDUCATION

FORMER EMPLOYERS (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)

DATE MONTH AND YEAR	NAME AND ADDRESS OF EMPLOYER	SALARY	POSITION	REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO

REFERENCES: (GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR).

NAME	ADDRESS	BUSINESS	YEARS ACQUAINTED

HAVE YOU BEEN EMPLOYED WITH THE CITY BEFORE ( ) NO ( ) YES EXPLAIN:

DO YOU HAVE ANY RELATIVE EMPLOYED BY THE CITY ( ) NO ( ) YES EXPLAIN:

"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU.

I UNDERSTAND AND AGREE THAT, IF HIRED MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR NOTICE."

DATE	SIGNATURE

MOTOR VEHICLE RECORD CHECK

The City of Marquette reserves the right to conduct a review of the driving records of applicants for employment. Employment may be contingent upon the possession of a good driving record.

DRIVER'S LICENSE NUMBER	EXPIRATION DATE

STATE OF ______IOWA ______OTHER (SPECIFY)

COMMERCIAL DRIVER'S LICENSE _____ NO _____ YES TYPES OF ENDORSEMENTS/ RESTRICTIONS (EXPLAIN):

I CERTIFY THAT ANSWERS GIVEN HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION FOR EMPLOYMENT AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result IN DISCHARGE. I understand, also, that I am required to abide by all rules and regulations of the employer.

Signature of Applicant	Date

Applicants Name (Printed/Typed)

AUTHORIZATION FOR EXAMINATION AND RELEASE OF INFORMATION

I,	do hereby authorize a review, full disclosure and release of any and all records concerning myself to any duly authorized officer, agent or employee of the City of Marquette whether the records are of a public, private, or confidential nature, with the following understandings:

The information reviewed, disclosed, or released may be used by the City of Marquette to determine employment eligibility.

I release the providers and users of the information collected pursuant to this authorization form any liability under state or federal privacy laws and further release the City of Marquette, its officers, agents and employees from any liability which may be incurred as a result of the collections and use of the information.

If this authorization is not sufficient to obtain access to certain records, it is understood that I may be requested to execute some other appropriate authorization or release, and that any failure to do so may be taken into consideration by the City of Marquette in their review of this application.

I understand that I may revoke this Authorization in writing at any time and the City of Marquette may take any such revocation of this Authorization into consideration in their review of the license application.

This authorization will automatically expire one year from the date signed.

A photocopy of this authorization will have the same force and effect as the original.

I also understand that under the Federal Fair Credit Reporting Act. I have the right to make a written request to this organization, within a reasonable time, for the disclosure of the nature and scope of the investigation. I authorize all persons and organizations to release any information concerning my background and hereby release all persons and organizations from liability for any damage whatsoever from this information.

_

Signature of Applicant	Date

Applicants Name (Printed/Typed)

VETERANS BENEFITS

Section 1. Section 19A.9, subsection 21, unnumbered paragraph 1, Code 1999, is amended to read as follows:

For veterans preference through a provision that veterans as defined in section 35.1 shall have five points added to the grade or score attained in qualifying examinations for appointment to jobs.

Sec. 2. NEW SECTION.

Definitions

As used in this chapter and chapters 35A through 35D:

"Commission" means the commission of veterans affairs created in section 35A.2.

a. "Veteran" means a resident of this state who served in the armed forces of the United States at any time during the following dates and who was discharged under honorable conditions:

World War I from April 6, 1917, through November 11, 1918.

Occupation of Germany from November 12, 1918, through July 11, 1923.

American expeditionary forces in Siberia from November 12, 1918, through April 30, 1920.

Second Haitian suppression of insurrections from 1919 through 1920.

Second Nicaragua campaign with marines in navy in Nicaragua or on combatant ships from 1926 through 1933.

Yangtze service with navy and marines in Shanghai or in the Yangtze valley from 1926 through 1927 and 1930 through 1932.

China service with navy and marines from 1937 through 1939.

World War II from December 7, 1941, through December 31, 1946.

Korean conflict from June 25, 1950, through January 31, 1955.

Vietnam conflict from February 28, 1961, through May 7, 1975.

Lebanon or Grenada service from August 24, 1982, though July 31, 1984.

Panama service from December 20, 1989, through January 31, 1990.

Persian Gulf conflict from August 2, 1990, through the date the president or the Congress of the United States declares a cessation of hostilities. However, if the United States Congress enacts a date different from August 2, 1990, as the beginning of the Persian Gulf conflict for purposes of determining whether a veteran is entitled to received military benefits as a veteran of the Persian Gulf conflict, that date shall be substituted for August 2, 1990.

"Veteran" includes the following persons:

Former members of the reserve forces of the United States who served at least twenty years in the reserve forces after January 29, 1973, and who were discharged under honorable conditions. However, a member of the reserve forces of the United States who completed a minimum aggregate of ninety days of active federal service, other than training, and was discharged under honorable conditions, or was retired under Title X of the United States Code shall be included as a veteran.

Former members of the Iowa National Guard who served at least twenty years in the Iowa National Guard after January 29, 1973, and who were discharged under honorable conditions. However, a member of the Iowa National Guard who was activated for federal duty, other than training, for a minimum aggregate of ninety days, and was discharged under honorable conditions or was retired under Title X of the Untied States Code shall be included as a veteran.

Former members of the active, oceangoing merchant marines who served during World War II at any time between December 7, 1941, and December 31, 1946, both dated inclusive, who were discharged under honorable conditions.

Former member of the women's air force service pilots and other persons who have been conferred veterans status based on their civilian duties during World War II in accordance with federal Pub. L. No. 95-202,38 U.S.C 106