Welcome To The City of Bloomfield New Mexico

Job Application Form

The City of Bloomfield is a government entity, subject to government regulations and affirmative action guidelines.

To assist with government reporting purposes, please fill out this confidential survey. The information that you provide on this survey is voluntary, confidential, and will not be kept with your application.  You are not required to provide the information on this form and refusal to provide such information will in no way affect your status as an applicant.

Pleae take a moment to complete our Affirmative Action Survey.doc, and submit to dclifton@bloomfieldnm.com

i.e. maiden name
Yes or No
If you are under 18, can you provide proof of eligibility to work?
Drivers License Number, State ID, or Student ID
Yes or NO. If yes, give the dates of employment
If so, who and what is the relationship?
Yes or No. (proof of U.S. Citizenship or immigration status will be required upon employment).
Full-time, Part-time, Temporary, Seasonal
Yes or No
Yes or No
Employer name, address & phone number
Employer name, address & phone number
Employer name, address & phone number
Employer name, address & phone number
Employer name, address & phone number
List specific skills and qualifications related to this job
English, Spanish, etc.
List professional trade, business, or civic associations and any offices held. (Exclude memberships that would reveal sex, race, religion, national origin, age, ancestry, disability or any other protected status).
Please fill out the survey at the top of this application. Thank you!