SEASONAL EMPLOYMENT APPLICATION

CITY OF BRIDGEPORT, CONNECTICUT

CIVIL SERVICE COMMISSION | CITY HALL, 45 LYON TERRACE, BRIDGEPORT CT 06604
CLICK TO VIEW Seasonal Position Informational Packet

Seasonal Position Information Packet

Seasonal Employment Application
Date*

MonthDayYear
Date
Position Applying For:*
APPLICANT INFORMATION
First Name*
Last Name*
Mailing Address*
Apartment/Unit
City/Town*
State*
ZIP*
Phone*
E-mail Address*
example@example.com
Commercial Drivers License (CDL) (Yes/No)*
CT Drivers License (Yes/No)*
Are you a citizen of the United States?*

YESNO
If no, are you authorized to work in the U.S.?*

YESNO
Have you ever worked for the City of Bridgeport before?*

YESNO
If so, when?
EDUCATION
High School
From

MonthDayYear
Date
To

MonthDayYear
Date
Did you graduate?*

YESNO
Degree
College/University
From

MonthDayYear
Date
To

MonthDayYear
Date
Did you graduate?

YESNO
Degree
Other
From

MonthDayYear
Date
To

MonthDayYear
Date
Did you graduate?

YESNO
Degree
REFERENCES

Please list three (3) professional references
Full Name*
Relationship*
Company*
Phone*
Full Name
Relationship
Company
Phone
Full Name
Relationship
Company
Phone
PREVIOUS EMPLOYMENT
Company*
Address*
Job Title*
Responsibilities*
From*

MonthDayYear
Date
To*

MonthDayYear
Date
Reason for Leaving*
Supervisor
May we contact your previous supervisor for a reference?

YESNO
Company*
Address*
Job Title*
Responsibilities*
From*

MonthDayYear
Date
To*

MonthDayYear
Date
Reason for Leaving*
Supervisor
May we contact your previous supervisor for a reference?

YESNO
Company
Address
Job Title
Responsibilities
From

MonthDayYear
Date
To

MonthDayYear
Date
Reason for Leaving
Supervisor
May we contact your previous supervisor for a reference?

YESNO
Attach Resume (if available)

Cancelof
Image of Resume (if available)
DEMOGRAPHICS
For purposes of Affirmative Action, we are requesting that you fill out the data below. This data will in no way be used to influence your possible selection for any position. The purpose of collecting this data is statistical and may help this office to determine whether advertising is reaching all segments of the community.
GENDER*

FEMALEMALE
ETHNICITY:

HISPANIC or LATINOWHITEASIANBLACK or AFRICAN AMERICANAMERICAN INDIAN or ALASKA NATIVENATIVE HAWAIIAN or PACIFIC ISLANDERTWO or MORE RACESOTHER
IN CASE OF EMERGENCY, PLEASE NOTIFY:
Name
Relationship
Cell Phone
Name
Relationship
Cell Phone
DISCLAIMER AND SIGNATURE
I certify that all information supplied on this application is accurate and truthful to the best of my knowledge. I understand that any misrepresentation of facts is cause for refusal of employment and/or termination of employment. I understand that, if I am hired as a seasonal or part-time employee, I am not eligible for any City of Bridgeport sponsored benefits. In the case of an emailed application, entering your name above will constitute an electronic signature. You may be asked to sign this application in person if you are offered a position with the City of Bridgeport.

It is the policy of the City of Bridgeport to employ, train, compensate, and promote individuals without regard to race, religion, national origin, sex, sexual orientation, age, disability, veteran status, or other characteristics protected by law.
Signature*

Clear
Should be Empty:

CITY OF BRIDGEPORT, CONNECTICUT

APPLICANT INFORMATION

EDUCATION

REFERENCES

PREVIOUS EMPLOYMENT

DEMOGRAPHICS

IN CASE OF EMERGENCY, PLEASE NOTIFY:

DISCLAIMER AND SIGNATURE