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Personal Information

First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Primary Phone *
Alternate Phone
Email Address*
Have you ever been convicted of, or entered a plea of guilty or nolo contendere to, a felony, misdemeanor criminal charge or local ordinance including one in which you received a suspended imposition osentence, suspended execution of sentence or any period of probation?*
1. Yes
1. No
If yes, please explain briefly below. Please provide the date, city, state and an explanation.
Are you legally eligible for employment in the U.S.?*
1. Yes
2. No
Are you over the age of 18?*
1. Yes
2. No
To the best of your knowledge, would you be able to perform all the essential functions of the position, with or without reasonable accommodations?
1. Yes
1. No
Are any of your relatives employed by the CITY OF WEBSTER GROVES?*
1. Yes
1. No
If yes, please state your relative's name and department.
Upload Resume
Upload cover letter, license, or certifications
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Position Information

What position are you applying for?*
Police Applicants Only: Provide POST certification number here.
Fire Applicants Only: Provide St. Louis County Class number here.
Are you available to work:
1. Full Time
1. Part Time
1. Seasonal/Temp.
How did you hear about the position?*
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Education

High School/GED
City, State
Did you graduate/earn GED?*
1. Yes
1. No
College
City, State
Degree/Major
Did you graduate/earn degree?
1. Yes
1. No
Additional College/Other Education
City, State
Degree/Certificate
Did you graduate/earn degree?
1. Yes
1. No
Professional licenses, certifications or registrations:
Software programs, applications, or other equipment you are qualified to operate or repair:
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Employment History and Military Service

Please list your employment for the past seven (7) years, with the most recent employment first. Please include all jobs within last seven (7) years, and use summary area following this section if necessary.
PLEASE NOTE: Stating "see resume" or leaving employer information blank for applicable employers in this section will not be considered a completed application.
Employer
Position
Supervisor Name, Job Title
Employer/Supervisor Phone Number
Employer Street Address, City, State, Zip Code.
Start Date
End Date
Hourly Rate/Annual Salary
Responsibilities
May we contact your previous supervisor for a reference?
1. Yes
1. No
Reason for leaving
Employer
Position
Supervisor Name, Job Title
Employer/Supervisor Phone Number
Employer Street Address, City, State, Zip Code.
Start Date
End Date
Hourly Rate/Annual Salary
Responsibilities
May we contact your previous supervisor for a reference?
1. Yes
1. No
Reason for leaving
Employer
Position
Supervisor Name, Job Title
Employer/Supervisor Phone Number
Employer Street Address, City, State, Zip Code.
Start Date
End Date
Hourly Rate/Annual Salary
Responsibilities
May we contact your previous supervisor for a reference?
1. Yes
1. No
Reason for leaving
Summarize other employment. Must include other employment within seven(7) years, and may include previous relevant experience. Please include employer name, position title, and dates of employment.
Military Service
Branch
From
To
Rank at Discharge
Type of Discharge
If other than honorable, please explain:
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References

Please list three professional references.
Full Name*
Relationship*
Company*
Phone Number*
Email
Years known
Full Name*
Relationship*
Company*
Phone Number*
Email
Years known
Full Name*
Relationship*
Company*
Phone Number*
Email
Years known
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Disclaimer & Signature

1. I certify that all statements are true and complete to the best of my knowledge. I authorize investigation of all information contained in this application.
2. I authorize any person, organization or company listed on this application to furnish to the City of Webster Groves any and all information concerning my previous employment, education and qualifications for employment, and hereby release any such person, organization or company from any liability that may result from furnishing such information.
3. I understand that any falsification, misrepresentation or omission of facts called for herein will be sufficient cause for rejection of my application for employment. In the event that I am employed, I understand that I may be terminated from employment in the event of any falsification, misrepresentation or omission of facts called for herein.
4. I understand that any position I am offered may be contingent upon my passing a physical examination, drug/alcohol test, and/or criminal background screening. I authorize the City of Webster Groves to obtain a copy of my criminal record from any law enforcement agency for use in processing this application.
5. I understand, based on the position I have applied for, I may be subject to additional testing/screening, including but not limited to a personality profile assessment. I further understand that I may be subject to a credit check in compliance with the Fair Credit Reporting Act (FCRA) regulations, and that if I am, I will be provided additional forms for this purpose.
6. I understand, if I am employed by the City of Webster Groves, that I will be required to provide verification of my identity and employment authorization to work in the U.S.
I understand and agree to the information above. IMPORTANT!! By entering your name and date below, you are legally signing your application.
Applicant Signature*
Date*
Date

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This field is not part of the form submission.
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