Start with your present or last job. Include any job-related military service assignments or volunteer activities. (You may exclude organizations which indicate gender, race, religion, national origin, age, ancestry, disability, or other protected status.) You may attach separate pages if additional space is needed.

I certify that the information and answers given herein are true and complete to the best of my knowledge. I authorize the City of Storm Lake to investigate all of the statements contained in this application for employment as may be necessary for arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by the City Administrator or (his/her) designee. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the City of Storm Lake.

In order for the City of Storm Lake to make a thorough investigation of my background, health, family history, personal habits, and reputation for the purpose of determining my fitness and suitability for employment with the City, I,: