Apply | City of Hiawatha, IA

*First Name:

*Middle Name:

*Last Name:

*Present Address:

*Present City:

*Present State:

*Permanent Address:

*Phone:

*Email:

*Can you, after employment, submit verification of your legal right to work in the U.S.?

No Yes

*Have you ever been convicted of a felony?

(A conviction record will not necessarily be a bar to employment; the circumstances will be considered.)

No Yes

Please Explain:

*Have you ever been in the Armed Services?

No Yes

Which Branch?

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