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Applicant Information

Application for Employment
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.
Position(s) Applied For*
Date
Date
How did you learn about us?
1. Advertisement
2. Employment Agency
1. Relative
2. Friend
1. Inquiry
1. Other
Name
Email Address
Address
City
State
Zip Code
Phone Number
Best time to contact you at home
Have you ever filed an application with us before?
1. Yes
1. No
If you are under 18 years of age, can you provide required proof of your eligibility to work?
1. Yes
1. No
Enter the date of your last application
Have you ever been employed with us before?
1. Yes
1. No
Enter the date of your last Town employment
Do any of your friends or relatives, other than spouse, work here?
1. Yes
1. No
Are you currently employed?
1. Yes
1. No
May we contact your present employer?
1. Yes
1. No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
1. Yes
1. No
Proof of citizenship or immigration status will be required upon employment.
Date available for work
Date available for work
What is your desired salary range?
Are you available to work:
1. Full-Time
1. Part-Time
1. Temporary
Please indicate 1st, 2nd or 3rd shift
1. 1st Shift
1. 2nd Shift
1. 3rd Shift
Please indicate Mornings, Afternoons or Evenings
1. Mornings
1. Afternoons
1. Evenings
Please indicate dates available
Please indicate dates available Start Date
—
Please indicate dates available End Date
Are you currently on "lay-off" status and subject to recall?
1. Yes
1. No
Can you travel if a job requires it?
1. Yes
1. No
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Education

Employment Experience

Military Experience
Have you ever served in the military?
1. Yes
1. No
Branch of Service
Dates served
Dates served Start Date
—
Dates served End Date
Rank at discharge
Military education and training
Employment Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected areas.
Employer
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Address
City
State
Zip Code
Phone Number
Job Title
Supervisor
Starting Salary
Ending Salary
Work Performed
Reason for leaving
Employer
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Address
City
State
Zip Code
Phone Number
Job Title
Supervisor
Starting Salary
Ending Salary
Work Performed
Reason for leaving
Employer
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Address
City
State
Zip Code
Phone Number
Job Title
Supervisor
Starting Salary
Ending Salary
Work Performed
Reason for leaving
Employer
Dates Employed
Dates Employed Start Date
—
Dates Employed End Date
Address
City
State
Zip Code
Phone Number
Job Title
Supervisor
Starting Salary
Ending Salary
Work Performed
Reason for leaving
List professional, trade, business or civic activities and offices held.
You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected areas.
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Applicant's Statement

Applicant's Statement
I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

By entering my name in the field below and selecting yes to "I Agree", you are acknowledging that you understand the above statement and that it is true to the best of your knowledge.
Name of Applicant
Today's Date
Today's Date
I agree with the above statement
1. Yes
1. No
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Additional Information

Additional Information
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
Other additional information
State any additional information you feel may be helpful to us in considering your application.
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
1. Yes
1. No
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.
References
Name
Email Address
Address
City
State
Zip Code
Phone Number
Name
Email Address
Address
City
State
Zip Code
Phone Number
Name
Email Address
Address
City
State
Zip Code
Phone Number

Leave This Blank:

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

This field is not part of the form submission.
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