application

Employment Application

  • Person to notify in case of emergency:
  • 3. Education
  • Date attended
  • 4. Health
  • 5. Employment History

    Give a complete account of your previous employment, including military service. List your most recent employer first.

  • 6. References (List 3 references, other than relatives)
    Name     Address    Phone    Years Known    Business Relationship
  • 7. Lifeguard Certifications
  • If yes, please provide a copy of your certificate to the Princeville Village Hall.
  • If yes, please provide a copy of your certificate to the Princeville Village Hall.
  • I am willing to have a medical examination. I authorize my former employers and listed references to give information concerning me, whether or not it is in their records, and I release them and their companies from any liability whatsoever. I certify that all statements given on this application are correct, and realize that falsification or misrepresentation of this or any other personal record may prevent employment, I agree to abide by all present and subsequently issued rules of the Village of Princeville.