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2. CITY OF ANACORTES
   P.O. Box 547, 904 6th Street, Anacortes, WA 98221 (360) 299-1970 | FAX (360) 299-1982 | www.cityofanacortes.org
4. The City of Anacortes is an equal opportunity employer. All applicants will be considered regardless of race, color, national origin, creed, religion, sex, age (over 40), pregnancy, marital status, physical or mental disability, genetic information, gender identification, sexual orientation, gender identity or status as an honorably discharged veteran, or any other class protected by federal, state, or local law. Equal access to the hiring process, services, and employment is available to all persons. Applicants requiring accommodations to the application and/or interview process should contact a representative of the Human Resource Department.
6. Instructions
   Instructions: Please type or print clearly in ink. Each question should be answered completely and accurately. Applicants are required to fill out a separate application for each position for which they apply. Please answer each question completely. No action will be taken on this application until all questions have been answered and the application has been signed and dated. Verification of eligibility to work in the U.S. will be required if an employment offer is made.
8. First Name*
9. Middle Initial
10. Last Name*
12. Please list any other name(s) used during employment or education
14. Address1*
16. Address2
18. City*
19. State*
20. Zip*
22. Home Phone*
23. E-Mail Address
25. Driver's License Number*
26. State
27. Expiration Date
29. Social Security Number
30. Birth date
    Birth date
32. List specific position applying for*
33. Date you tested with Public Safety Testing.com?
    Date you tested with Public Safety Testing.com?
35. Have you filed an application here before?

    1. Yes
    2. No
36. If yes, give date
    If yes, give date
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

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