Employment Application

Please print this page, complete the application, and fax, mail or deliver in person:

DeSoto Civic Center Human Resources
Fax: 662.280.5927
4560 Venture Drive
Southaven, MS 38671

Application For: Ticket Seller

 
First Name: Middle Name: Last Name: Email Address:
Street Address or PO Box: City: State: Zip:
Home Phone: Cell Phone: Last Four Digits Of Social Security #:
If you are under 18, and if required, can you furnish a work permit?
Yes No  (please explain)
Have you ever been employed with DCC before?
Yes No
Are you legally eligible for employment in this country?
Yes No
Are you able to meet the attendance requirements of the position?
Yes No
Type of employment desired?
Full Time Part Time Temporary Seasonal Educational Co-Op
Have you ever pled “guilty”, “no contest” to, or been convicted of a crime?
No Yes (please provide dates and details)
CONVICTION WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. EACH INSTANCE AND EXPLANATION WILL BE CONSIDERED IN RELATION TO THE POSITION FOR WHICH YOU ARE APPLYING
List anyone you know anyone that works at DeSoto Civic Center:
Name Relationship
Employment History, Most Recent First: (Fill In One Minimum)
From To Employer Name Telephone  
Job Title   Address City State
Immediate Supervisor / Title Job Summary & Responsibilities
Start Pay Final Pay Reason For Leaving  
Employment History:
From To Employer Name Telephone  
Job Title   Address City State
Immediate Supervisor / Title Job Summary & Responsibilities
Start Pay Final Pay Reason For Leaving  
Employment History:
From To Employer Name Telephone  
Job Title   Address City State
Immediate Supervisor / Title Job Summary & Responsibilities
Start Pay Final Pay Reason For Leaving  
Employment History:
From To Employer Name Telephone  
Job Title   Address City State
Immediate Supervisor / Title Job Summary & Responsibilities
Start Pay Final Pay Reason For Leaving  
Military Service:
From To Rank At Discharge Branch
Skills & Qualifications:
Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying:
Educational Background: (High School Information Minimum)
  Name & Location Years Completed Degree Studies
High School
College
Other
References: (Two Minimum)
Name Occupation Address Phone Years Known
Availability To Work
Start Date: Morning Hours: Afternoon Hours: Evening Hours:

DISCLOSURE AGREEMENT

I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer’s service, whenever it is discovered.

I give the employer the right to contact and obtain information from all references, employers, and educational institutions and to otherwise verify the accuracy of the information contained in this application.  I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.

The employer does not unlawfully discriminate in employment and no questions on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state, or federal law.

This application is current for only 90 days.  At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without proper notice, and the employer reserves the same right to terminate my employment, at any time, with or without cause and without prior notice, except as may be required by law.  This application does not constitute an agreement or contract for employment for any specified period or definite duration.  I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary.  I further understand that any such assurances must be in writing and signed by the board.

I understand it is this company’s policy not to refuse to hire qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

I understand and agree that falsification of information may cause dismissal of my application and/or immediate termination.

__________________
Date

__________________________________________
Signature

An Equal Opportunity Employer