Employment Application

 

Town of Pound

 

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, sexual orientation, or any other legally protected status.

 

Position Applied For:                                                                           Date:                                      

 

 

 

Last Name:                                          First Name:                                                      MI:                  

 

Address:                                                          City:                             State: _____Zip:                     

 

Telephone #:                                                   Email:                                                                                    

 

Do you have a current valid drivers license?              Yes                 No

 

Do you have a current valid Commercial Drivers License?                Yes                  No

 

 If No, would you be willing to established one within a reasonable time limit?      Yes      No

 

Are you 18 years of age or older?                   Yes                  No

 

Are you currently employed?              Yes                  No

 

May we contact your present employer?                   Yes                  No

 

Are you prevented from lawfully becoming employed by the Town of Pound because of Visa or Immigration Status?                        Yes                  No

 

Are you available to work:                  Full Time                     Part Time

 

Are you currently on “lay-off” status and subject to recall?             Yes                   No

 

Can you travel if a job requires it?                 Yes                  No

 

Have you been convicted of a felony within the last 7 years?               Yes          No

 

Conviction will not necessarily disqualify applicant from employment.

 

If yes, please explain:

 

 

 

 

 

 

 

 

 

 

 

Education

 

High School:                                                                                                                                       

 

College:                                                                        Degree:                                                         

 

Professional:                                                                Degree:                                                         

 

Other (Specify):                                                            Degree:                                                         

 

Foreign Language you speak, read, and/or write:                                                                             

 

Describe specialized training, apprenticeship, skills, and extracurricular activities:

 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           

 

 

 

Describe any job-related training received in the United States Military:

 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

 

 

 

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 status.

 

  1. Employer:                                                                                            Dates Employed:

    Address:                                                                                          From:                   To:                 

    Telephone #:                                                               Hourly Rate/Salary:                                        

    Job Title:                                                                      Supervisor:                                                     

    Work Performed:

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

     

    Reason for Leaving:                                                                                                                                                                                                                                                                                       

  2. Employer:                                                                                            Dates Employed:

    Address:                                                                                         From:                    To:                 

    Telephone #:                                                               Hourly Rate/Salary:                                        

    Job Title:                                                                      Supervisor:                                                     

    Work Performed:

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

     

    Reason for Leaving:                                                                                                                                                                                                                                                                                       

     

  3. Employer:                                                                                            Dates Employed:

    Address:                                                                                        From:                     To:                 

    Telephone #:                                                               Hourly Rate/Salary:                                        

    Job Title:                                                                      Supervisor:                                                     

    Work Performed:

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

     

    Reason for Leaving:                                                                                                                                                                                                                                                                                       

     

  4. Employer:                                                                                            Dates Employed:

    Address:                                                                                       From:                      To:                 

    Telephone #:                                                               Hourly Rate/Salary:                                        

    Job Title:                                                                      Supervisor:                                                     

     

    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 status.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           

     

     

     

    Applicant’s Statement

    I certify that answers given herein are true and complete to the best of my knowledge.

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

    I understand that this application is not and is not intended to be a contract of employment.

    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.

     

    Signature of Applicant:                                                                       Date: