top of page

2018

Home
Government
City Services
Residents
Visitors
How Do I...
- Apply
  Business License
  Employment
- Contact
  Board of Aldermen
  Departmental Staff
  Police & Fire Department
- Pay
  Court Tickets
  Utilities
- Register
  Voter Registration
  Renew Car Tag
  Youth Sports
- Report
- Request
  Public Request
- View
  Agendas & Minutes
  Annual Budget
  Bid Openings
  City Projects
  Events in Long Beach
  News and Updates
- Harrison County Development Commision
Connect
Photos

City of Long Beach Application for Employment

Position*

Personal History

First name*

Last name*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Email*

Phone

Are you a citizen of the United States?*

Yes

No

Have you ever legally changed your name?*

Yes

No

If yes, please provide:

If you have been naturalized:

Date/Certificate Number

List all other names, including nicknames, that you have held:

Education:

Elementary School*

Name/Address of School

Graduated Yes/No

Type of Degree

Grade Finished

High School*

Name/Address of School

Graduated Yes/No

Type of Degree

Grade Finished

College/University

Name/Address of School

Graduated Yes/No

Type of Degree

Grade Finished

Graduate/Professional

Name/Address of School

Graduated Yes/No

Type of Degree

Grade Finished

Special Training

Have you ever served in the United States Armed Forces?*

Yes

No

If yes, please submit a copy of DD form 214.

Employment History

Company name*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Telephone Number

Position*

Start Date*

Month

Day

Year

Last Day*

Month

Day

Year

Reason for Leaving*

Duties*

Company Name*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Telephone Number

Start Date*

Month

Day

Year

Last Day*

Month

Day

Year

Reason for Leaving*

Duties*

Company Name*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Telephone Number

Start Date*

Month

Day

Year

Last Day*

Month

Day

Year

Reason for Leaving*

Duties*

Company Name*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Telephone Number

Start Date*

Month

Day

Year

Last Day*

Month

Day

Year

Reason for Leaving*

Duties*

Company Name*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Telephone Number

Start Date*

Month

Day

Year

Last Day*

Month

Day

Year

Reason for Leaving*

Duties*

Company Name*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Telephone Number

Start Date*

Month

Day

Year

Last Day*

Month

Day

Year

Reason for Leaving*

Duties*

Court Record

Driver's License

Number/State/Expiration Date

Have you ever been arrested or charged with any violation, including traffic tickets, but not parking tickets?*

Yes

No

If yes, dive details below:

Additional Information

Are you related by blood or marriage to any employee of the City of Long beach or Harrison County?*

Yes

No

If yes, please provide the following information:

Name/Relationship/Official Title

Do you hold any political or party office?*

Yes

No

If yes, please provide title of position and date of election or appointment

Have you ever taken an examination given by the City of Long Beach Civil Service Commission?*

Yes

No

If so, give the title and date of the exam.

Will you accept temorary employment?*

Yes

No

Do you understand that if selected for appointment, you may be required to pass medical/physical exam, alochol and drug screening tests, and that failure to meet requirements may result in being disqualified?*

Yes

No

Please provide the County and State where you are registered to vote.*

If you would like to make a statement about special qualificiations, please do so in this area:

References

Please give three references, not family related, known to you during the past five years.*

Name/Address/Telephone Number

Upload Recent Full Face Photograph*

Upload a Copy of your Birth Certificate*

Upload a Copy of DD-214 if prior Military Service

Upload a Copy of High School Diploma or GED*

Upload a Copy of Driver's License*

Upload a Copy of Social Security Card*

FIND US

Long Beach MS, City Hall

201 Jeff Davis Ave

Long Beach, MS 39560

228.863.1556

bottom of page