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2603 Santa Clara Drive | Santa Clara, UT 84765 | (435) 673-6712
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Option 1
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Previously employed with City?
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When and what department?
Are you able to perform the job duties with or without accommodation?
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If accommodation were necessary, how would you perform the job?
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Have you ever been convicted of an offense against the law and/or are now under charges for any offense?
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Omit non-moving traffic violations and any offense that was finally adjudicated in a Juvenile Court or under a Youth Offender Law. NOTE: A conviction will not necessarily bar you from employment. Each conviction will be judged on its own merits with respect to time, circumstances and seriousness.
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Employment History
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Describe work history beginning with your current or most recent employer. Include applicable volunteer experience and explain any breaks in employment. Failure to provide complete information regarding any job may result in disqualification of your application. A resume may be attached only as additional information and will not be accepted in lieu of completing this section. Please include in this section: Employer Name, Phone, Address, Dates Employed, Position Held, Supervisor, Ending Salary, Reason for Leaving, Description of Duties.
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Must also complete above description with all required information.
Additional Information
Comment on any additional skills, experience or accomplishments that relate to the position for which you are applying. Some examples are skills with machinery or equipment, writing or public speaking skills, membership in professional organizations, etc.
Employment Application Agreement
Please read the following statement carefully before signing application: I hereby declare the information provided by me in this application to be true and complete. I understand that incorrect information, omissions of fact, or falsification of any information on the application will be grounds for refusal to hire, or if hired, grounds for termination. I authorize the City of Santa Clara to request, receive and verify all information given in this application. If I am employed by the City of Santa Clara, I agree to conform to the policies, rules and regulations governing employment that have been adopted. It is acknowledged that these policies, rules and regulations may be changed, interpreted, withdrawn or added to by the City at any time, at the City’s sole option. As a condition of employment with the City, I will be required to submit to an alcohol and controlled substance screening test. Additionally, if hired, I will abide by the City’s policy regarding the use of drugs and unlawful possession of controlled substances. I will report any conviction under a criminal drug statute to the Human Resources Department within five (5) days of the conviction
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