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City of Riverdale, Iowa
110 Manor Drive, Riverdale, Iowa 52722 (563) 355-2511 www.riverdaleia.org
Employment Application
APPLICANT INFORMATION
Last Name First M.I.
Current Address
City State Zip
Phone Email
Position Applied For FT/PT/Seasonal
Are you 18 years or older? ☐ Yes ☐ No Are you legally able to work in the US? ☐ Yes ☐ No
EDUCATION
Name City/State Degree/Subject Year
College
Vocational Training
High School
Other
Additional training/skills (e.g., machines, equipment, computer skills, etc.)
Certifications/licenses/endorsements, etc.
EMPLOYMENT HISTORY List 7 years of employment, most recent first. Add additional pages if necessary.
Company Phone
Address
City of Riverdale, Iowa
110 Manor Drive, Riverdale, Iowa 52722 (563) 355-2511 www.riverdaleia.org
Supervisor Name Email
Job Title Rate of Pay
Responsibilities
Start Date End Date
Reason for Leaving
Company Phone
Address
Supervisor Name Email
Job Title Rate of Pay
Responsibilities
Start Date End Date
Reason for Leaving
Company Phone
Address
Supervisor Name Email
Job Title Rate of Pay
Responsibilities
Start Date End Date
Reason for Leaving
MILITARY SERVICE
Are you a military veteran? ☐ Yes ☐ No
If yes, dates of active duty: to
City of Riverdale, Iowa
110 Manor Drive, Riverdale, Iowa 52722 (563) 355-2511 www.riverdaleia.org
REFERENCES List three professional references.
Name Relationship
Company
Email Phone
Name Relationship
Company
Email Phone
Name Relationship
Company
Email Phone
DISCLAIMER AND SIGNATURE
I, the applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my
eventual employment, I understand that any false or misleading information in my application or interview may result in my
immediate termination.
I consent to having this application and any accompanying documents treated as public record. ☐ Yes ☐ No
[NOTE: A "no" answer will have no effect on hiring decisions. "No" is the typical answer.]
Signature Date
Prior to an offer of employment, applicant must pass a background check and, if required by the specific position, hold a val id
driver's license. The City of Riverdale is an Equal Opportunity Affirmative Action Employer. The City of Riverdale complies
with the Americans with Disabilities Act. Any offer of employment is at-will and no guarantee of continued employment is
made.
Submit application materials to: Direct questions to:
Email: clerk@riverdaleia.org Email: clerk@riverdaleia.org
Mail or in-person: City of Riverdale Mail or in-person: City of Riverdale
110 Manor Drive 110 Manor Drive
Riverdale, Iowa 52722 Riverdale, Iowa 52722
Phone: (563) 355-2511 ext. 201