The entrance to the park on the Frank E. Simon side, including the road to the baseball fields, is now closed for construction.  We will keep you updated as the construction progresses.  Thank you for your patience.

502-543-2923 Mon-Thurs 8AM - 5PM & Fri 8AM - 12PM
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Home > Employment Application

Employment Application Form

Applicant Information

Name(Required)
Address(Required)
MM slash DD slash YYYY
Can you perform the essential functions of the position you are applying for?(Required)
Do you have any friends or relatives employed by this company?(Required)
If hired, can you provide proof of US citizenship or your legal right to work in the United States?
Have you ever worked for this company?(Required)
Have you ever been convicted of a felony?(Required)

Education

Do you have a high school diploma or GED?
School Address
MM slash DD slash YYYY
MM slash DD slash YYYY
Did you graduate?(Required)
School Address
MM slash DD slash YYYY
MM slash DD slash YYYY
Did you graduate?(Required)

References

Please list three professional references. This should be coworkers, supervisors, managers, etc who have direct knowledge of your work.
Full Name
Company
Phone
Email
 

Previous Employment

List below all present and past employers over the past ten years, starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume.

May we contact your current employer?(Required)
Address
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact your previous supervisor for a reference?
Address
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact your previous supervisor for a reference?
Address
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact your previous supervisor for a reference?

Military Service

MM slash DD slash YYYY
MM slash DD slash YYYY

Disclaimer and Signature

I authorize investigation of all statements contained in this application for any employment-related purpose. I release the listed references and all employers to provide you with any and all applicable information they many have. I certify the facts contained in this application are true and complete to the best of my knowledge and I understand that falsified statements in this application may result in denial of employment, or termination of my employment. I understand and agree that if hired, my employment is at-will and either the company or I can terminate the employment relationship at any time and for any reason. City of Shepherdsville is an Equal Employment Opportunity (EEO) employer. In compliance with Title VI of the Civil Rights Act of 1964, we do not discriminate against job applicants based on race, color, gender, age, national origin, mental or physical disability, veteran or family status, genetic information, religion or any other status or condition protected by applicable federal, state or local laws, except where a bona fide occupational qualification applies.

Clear Signature
MM slash DD slash YYYY
Max. file size: 100 MB.
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Community

History
Bullitt County
Events and News
Documents and Forms
Garbage
Services and Utilities
Planning and Zoning

Business

Start a Business
Doing Business with City
Business Resources
Building Resources
Business Directory

City Departments

City Administration
Engineering
Fire Department
Police Department
Parks and Recreation
Public Works
Stormwater MS4
Wastewater Department
Louisville Water

502-543-2923
634 Conestoga Pkwy
Shepherdsville, KY 40165
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Office Hours
Mon-Thurs 8am-5pm
Fri 8am-12pm

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