OF AGU  6 COLORADO  Town of Aguilar 101 W. Main Street PO Box 538 Aguilar, CO 81020 Ph: 719-941-4360 Fax: 719-941-4395 Donald Gonzales  Mayor  Employment Application  Applicant Information  Full Name: Address:  Date:  Last Street Address City  First  M.I.  ApartmentUnit# ZIPCode  State  Phone: Date of Birth: Position. Applied for: Date Available:  Email  Social Security No.:  Desired Salary:$  YES NO YES NO J D Ifyes, when? YES NO D  YES NO D  Are you a citizen of the United States? Have you ever worked fort this company? Have you ever been convicted of at felony?  J D Ifno, are you authorized to worki int the U.S.? L  Ifyes, explain: High School: From: College: From: Other: From:  Education Address:  YES NO  To:  Did you graduate? D D Diploma:  Address:  YES NO  To:  Did you graduate? D D Degree:  Address:  YES NO  To:  Did yous graduate? D D Degree:    References  Please list three professional references.  Full Name: Company: Address: Full Name: Company: Address: Full Name: Company: Address: Company: Address: Job Title: Responsibilities: From:  Relationship: Phone: Relationship: Phone: Relationship: Phone:  Previous Employment  Phone: Supervisor: Ending Salary:$  Starting Salary:$  To:  Reason for Leaving: YES D  NO D  May we contact your previous supervisor for a reference?  Company: Address: Job Title: Responsibilities: From:  Phone: Supervisor: Ending Salary:$  Starting Salary:$  To:  Reason for Leaving: YES L  NO D  May we contact your previous supervisor fora ar reference?  Company: Address: Job Title:  Phone: Supervisor: Ending Salary:$  Starting Salary:$  2    Responsibilities: From:  To:  Reason for Leaving: YES D  NO D  May we contact your previous supervisor for ar reference?  Special Skill (Heavy equipment knowledge and operating, computer skills, etc.)  Military Service Branch: Rank at Discharge: Ifother than honorable, explain:  From:  To:  Type of Discharge:  Disclaimer and Signature  Icertify that my answers are true and complete to the best of my knowledge.  Ift this application leads to employment, lunderstand that false or misleading information in my application or  interview may result in my release.  Signature:  Date:  3