Employment Application

Job Data
Position Applying for:*
Date you will be available:*
Date Format: MM slash DD slash YYYY
Personal Data
Name*
First Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Do you have the legal right to work in the U.S.?*
- Yes
- No
Date of Birth:
Date Format: MM slash DD slash YYYY

(If you are younger than 18)
Have you ever worked for the town?*
- Yes
- No
Please give dates:*
Do you have any relatives employed with the Municipality?*
- Yes
- No
Please list:*
Name Department Relationship
Have you had any traffic convictions or accidents in the last three years?*
- Yes
- No
Please list:*
Conviction/Accident Date
Driver's License #*
State of License:*
State
License Class:*
- A
- B
- C
Endorsement:
License Expiration Date:*
Date Format: MM slash DD slash YYYY
Have you been convicted of a crime?*
- Yes
- No
Please explain:*
Education
Did you graduate or do you have a G.E.D.?*
- Yes
- No
High School:
Higher Education:
Name of School, College(s) or University, Trade/Technical or Business School Major/ Course of Study Credit Hours Degree/Diploma
Skills Overview
Tell us about yourself...
List computer software/programs that you use:
Summarize relevant skills and experience that applies for the advertised position:*
List tools/machines you can operate:
List light/heavy equipment you can operate:

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Employment History
Resumes may be attached, but will not be accepted in lieu of a completed application. Start with your most recent job and work backwards. If you do not specify whether or not to contact past employers, we will.
Current or most recent employer:*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Title:*
Employment Start Date:*
Date Format: MM slash DD slash YYYY
Employment End Date:
Date Format: MM slash DD slash YYYY
Supervisor's Name & Title:*
First Last Title
Starting Salary:*
Present/Ending Salary:*
Hours per week:*
Work Performed:*
Reason for Leaving:*
May we contact this employer if you are considered for the position?*
- Yes
- No
Employer 2:
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Title:
Employment Start Date:
Date Format: MM slash DD slash YYYY
Employment End Date:
Date Format: MM slash DD slash YYYY
Supervisor's Name & Title:
First Last Title
Starting Salary:
Present/Ending Salary:
Hours per week:
Work Performed:
Reason for Leaving:
May we contact this employer if you are considered for the position?
- Yes
- No
Military Service
Have you ever served on active duty in the U.S. armed forces?*
- Yes
- No
Date Entered Service:*
Date Format: MM slash DD slash YYYY
Date Retired from Service:
Date Format: MM slash DD slash YYYY
Branch:*
Primary Duties:*
References:*
Name Position/Relationship Phone #

(may not be relatives/employees)

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Conditions of Consideration for Employment
Conditions of Consideration for Employment
I have read and understand the above "Conditions of Consideration for Employment."*
- Yes
- No
By typing your name here you acknowledge that your electronic signature is the legal equivalent of your consent to the above conditions:*
First Last
Date:*
Date Format: MM slash DD slash YYYY

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Job Data

Name	Department	Relationship

Conviction/Accident	Date

Name of School, College(s) or University, Trade/Technical or Business School	Major/ Course of Study	Credit Hours	Degree/Diploma

Name	Position/Relationship	Phone #