Use the form below to apply for employment with the City of Martinsville. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Personal InformationFull Name *FirstMiddleLastDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Phone *Email *Driver's License #Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmployment DesiredGas DepartmentWater/Wastewater DepartmentStreets and AlleysPolice DepartmentCity Hall / OfficeSummer HelpDesired Position *Preferred Work Schedule *Salary Expectations *Date Available to Start *Please explain why you would like to work for the City of Martinsville.Why should the City of Martinsville hire you?Employment and EducationCurrent Organization *Employment Start Date *Degree/Diploma *Professional Certifications *Job Title *Reason for Leaving *School Name *Relevant Training or Courses *Previous Employer #2OrganizationEmployment Start DateProfessional CertificationsRelevant Training or CoursesJob TitleEmployment End DateReason for LeavingSchool NamePrevious Employer #3Organization (copy)Employment Start Date (copy)Professional CertificationsRelevant Training or CoursesJob Title (copy)Employment End Date (copy)Reason for LeavingSchool NameJob Responsibilities and AchievementsAttach Resume/CV Click or drag a file to this area to upload. Attach Cover Letter Click or drag a file to this area to upload. ReferencesPlease provide names of two persons not related to you, whom you have known at least one year.Reference 1 NameReference 2 NameRelationshipRelationshipContact InformationContact InformationConsent and AgreementAre you legally authorized to work in the United States? *YesNoDo you authorize a background check as part of the employment? *YesNoHave you ever been convicted of a felony? *YesNoThe City of Martinsville is an Equal Opportunity EmployerIt is the policy of the City of Martinsville that its employees and applicants for employment will be free from any discrimination or harassment based on race, color, religion, gender, sexual orientation, marital status, national origin, ancestry, physical or mental disability, or age. The City of Martinsville is an Equal Opportunity Employer and provides reasonable accommodation to applicants and employees with disabilities.Applicant's Signature * Clear Signature I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facets called for is cause for dismissal. Further, I understand and agree that my employment if for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice. I understand that filling out this form does not indicate there is a position open and does not obligate the company to hire. If hired, I agree to abide by all City of Martinsville work rules, policies and procedures. The City of Martinsville retains the right to revise its policies or procedures, in whole or in part, at any time.Date of Application *Submit