Election Inspector Application

2. Election Inspector Application

   The City of Delafield is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, age, sex, religion or national origin

   The City of Delafield is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, age, sex, religion or national origin

4. How did you find out about the position?*

6. First name, Middle Initial, Last Name*

8. Address*

9. City, State, Zip*

11. Phone*

12. Email*

14. Are you legally entitled to work in the United States?*

    1. Yes
    2. No

16. Are you age 18 or over?*

    1. Yes
    2. No

17. If no, enter date of birth:

19. Do you possess a valid driver's license?*

    1. Yes
    2. No

20. License Number:*

22. Special skills and qualifications that may apply to the position *

    (please include all computer software which you can operate skillfully)

24. Other Information

26. 1. Are you currently a registered member of a political party?*

    1. Yes
    2. No

27. If yes, please indicate:

    1. Democratic
    2. Republican

29. Have you ever served as an election official?*

    1. Yes
    2. No

30. If yes, please indicate where and when:

32. 3. I would like the following special considerations, if possible (Examples: to work with specific other individuals, to be able to leave the site for mealtimes, accessibility needs etc.):

34. Have you ever been convicted of any violations of law other than minor traffic violations?*

    1. Yes
    2. No

36. If yes, for what have you been convicted, when, where and penalty imposed?

    Note: Convictions are not an automatic bar to employment, but are reviewed in relation to the job for which you applied. Convictions not reported may be cause for discharge.

38. CAREFULLY READ THIS APPLICATION AND YOUR ANSWERS AND THE CERTIFICATION AND AGREEMENT BELOW BEFORE SIGNING. APPLICANT’S CERTIFICATION AND AGREEMENT

    I certify that answers given herein are true and complete to the best of my knowledge. I understand and agree that any misstatements or omissions of material fact herein subjects me to disqualification or dismissal. I authorize the City of Delafield to make such investigation of my medical history, as may be necessary only after I have received a conditional job offer by the City of Delafield. I also understand that covered employees are compensated for overtime work in accordance with the Fair Labor Standards Act. Applicants should discuss overtime pay practices with the appointing authority prior to accepting employment with the City of Delafield. By Submitting this form, you have read and understand the information in this application and will adhere to all rules and regulations set forth by the City of Delafield.

    I certify that answers given herein are true and complete to the best of my knowledge. I understand and agree that any misstatements or omissions of material fact herein subjects me to disqualification or dismissal. I authorize the City of Delafield to make such investigation of my medical history, as may be necessary only after I have received a conditional job offer by the City of Delafield. I also understand that covered employees are compensated for overtime work in accordance with the Fair Labor Standards Act. Applicants should discuss overtime pay practices with the appointing authority prior to accepting employment with the City of Delafield. By Submitting this form, you have read and understand the information in this application and will adhere to all rules and regulations set forth by the City of Delafield.

40. Thank you for completing this application and for your interest in employment with us. We would like to assure you that your opportunity for employment with the City of Delafield will be based on your merit and qualifications and no other consideration.

44. Office Use Only

46. Interviewed By

47. Date Interviewed
    Date Interviewed

49. Notes, Comments, Reccmoendations

51. Appointment Date

53. Job Title

54. Department

56. Salary/ Hourly Rate

57. Employee Number

Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field