Employment Application

Required fields are marked with asterisks (*)

Date:

Position Applying For:

Full Name:

Name preferred to be called:

Mailing Address:

City:

State:

Zip:

Physical Address:

City:

State:

Zip:

Phone Number:

Other:

DOB:

Last 4 Digits of SS#: XXX-XX-

Email Address:

Have you worked for the City of Mercedes before?

Yes

Are you related to any elected official or employee of the city?

Yes

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