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City of Cottonwood Application

  1. Application for Employment

  2. City of Cottonwood

    816 N. Main Street, Cottonwood, AZ 86326 Phone: (928) 340-2717 Fax: (928) 634-3727 E-mail:

  3. If P.O. Box is used, applicant MUST provide physical and mailing address.

  4. If different from above.

  5. Your qualifications will be evaluated on the basis of the information provided in this application. Although resumes are encouraged, do not enter the words "see resume" in lieu of information requested on the application form. Resumes will not be considered without a fully completed application.

  6. Read the following instructions carefully before filling out your application for employment.

  7. All requested information must be furnished. Fill in all spaces of the application accurately and completely. If an item does not apply to you, or if there is no information to be given, write in the letters “N/A” for not applicable.

  8. New hires for safety-sensitive City positions are required to complete – and pass – a post-offer physical examination and drug screening at the City’s expense. Applicants 18 years of age and older will also be required to provide their fingerprints on a standard, Federal Bureau of Investigation (FBI) applicant card or present a valid Level 1 fingerprint card upon employment. Your fingerprint card will be forwarded to the Arizona State Department of Public Safety and FBI for review. Criminal history information revealed by the State or FBI may be grounds for rejection and/or termination from employment. Certain positions require polygraph testing prior to employment. A criminal conviction does not constitute an automatic bar to employment. If a position uses FBI criminal history to determine suitability of an applicant for employment, license, or benefit, the applicant is afforded the opportunity to challenge the accuracy of the record and assure that the record is complete. You are advised that the procedures for challenging, correcting, and updating an FBI criminal history record are contained in Title 29, Code of Federal Regulations (CFR), section 16.34. If you feel your criminal history is inaccurate or incomplete, you may request information from the HR Department to begin the review and challenge process.

  9. In submitting this application, I understand that false statements or omissions may disqualify me for employment or constitute grounds for dismissal. I understand that, if accepted for employment, I will be required to provide proof of identity and eligibility to work in the United States in addition to signing a loyalty oath as a condition to receiving any compensation from the City. Also, I authorize all former employers, schools and references to release information that they may have about me to the City of Cottonwood or its agents.

  10. By typing my name below, I acknowledge that I have read – and understand – the above statements. Further, I understand and acknowledge that, unless otherwise defined by applicable law, during my orientation period, I am an “at will” employee, and may resign at any time or the City may discharge me at any time, for any or no reason. It is further understood that the “at will” employment relationship which would be created if I am hired may not be changed by any oral or written communication, unless such change is specifically acknowledged, in writing, by the City.

  11. Acknowledgement*

  12. You will accept:*

  13. Shifts you will accept:*

  14. You learned of this position by:

  15. A. Have you ever worked for the City of Cottonwood?*

  16. B. Are any of your relatives, either by blood or marriage, employed by the City of Cottonwood?*

  17. D. Are you 15 years of age or older?*

  18. E. Have you ever been discharged, requested, or forced to resign from any position?*

  19. F. Have you ever had a legal suit or claim filed against you as an employer, or as a representative of an employer?*



  22. Did you receive a high school diploma or obtain a GED?*

  23. Colleges/Universities Attended and Degree (if any):

  24. Trade, Technical, Business, Correspondence, or other Schools and Courses Studied:


  26. Be accurate and complete. Provide the following information with respect to every position of employment, including self-employment that you have held for the past ten (10) years. Add additional pages if required.

  27. Present or Most Recent Job:

  28. May we contact your present employer prior to employment?

  29. The City of Cottonwood is an Equal Opportunity Employer, and it is the policy of the City to make all recruitment, hiring, and placement decisions, as well as other employment decisions, on the basis of the qualifications of the individuals considered for the position to be filled, without regard to race, ethnicity, age, sex, religion, color, national origin, sexual orientation, veteran’s status, or non-disqualifying handicap.

  30. If you would like to upload any documents, please do so here.

  31. Voluntary Self Identification of Race/National Origin and Gender

  32. Gender:

  33. Anti-Discrimination Notice

    It is an unlawful employment practice for an employer to fail or refuse to hire or discharge any individual, or otherwise to discriminate against any individual with respect to that individual’s terms and conditions of employment, because of such individual’s race, color, religion, gender, or national origin.

  34. This employer is subject to certain nondiscrimination and affirmative action recordkeeping and reporting requirements which require the employer to invite employees to voluntarily self-identify their race/national origin and gender. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable federal laws, executive orders, and regulations, including those which require the information to be summarized and reported to the Federal Government for civil rights enforcement purposes.

  35. If you choose not to self-identify your race/national origin and gender at this time, the federal government requires this employer to determine this information by visual survey and/or other available information.

  36. For civil rights monitoring and enforcement purposes only, all race/national origin information will be collected and reported in the seven categories identified below. The definitions for each category have been established by the federal government. If you choose to voluntarily self-identify, you may mark only one of the boxes presented below.

  37. Invitation to Self-Identify

    Please answer the following question.

  38. What is your race/national origin? Please mark the one box that describes the race/national origin category with which you primarily identify.

  39. Leave This Blank:

  40. This field is not part of the form submission.