Email*
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Position(s) Applying For (Check all that apply)*
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Seasonal Pool Employment – Lifeguards and Admission Personnel
Part-time Patrolman
Full-time DPW Worker
Other
Other Position Applying For
How did you hear about this position?
Desired Hours
Please Select
Full Time
Part Time
Seasonal Full Time
Seasonal Part Time
High School Name
High School Diploma
Have you attended, or currently attend, undergraduate college/university?
Yes
Currently Attending
No
Name of Undergraduate College/University
Undergraduate College/University Degree
Undergraduate College/University Course of Study
Undergraduate College/University Years of Study
Have you attended, or currently attend, graduate/professional college/university?
Yes
Currently Attending
No
Name of Graduate/Professional College/University
Graduate/Professional College/University Degree
Graduate/Professional College/University Course of Study
Graduate/Professional College/University Years of Study
List any seminars, classes or other education not listed above which may help qualify you for this position.
Employer
Email Address of Supervisor
Are you currently employed here?
Yes
No
Pay Type
Please Select
Hourly
Salaried
Third Choice
Starting Pay
Ending Pay
Job Position(s)
Reason(s) for Leaving (Or Wanting to Leave if Currently Employed)
Essential Job Functions of Final Position
What value did you add to this company or its customers?
List any professional, trade, business or civic activities and offices held. You may exclude membership that would reveal gender, race, religion, national origin, ancestry, age, disability or any other protected status.
Are there any languages other than English that you can speak, read or write that could be of benefit to the position applied for?
Yes
No
Please list the language(s) and what level of fluency you have in speaking, reading, and writing below.
Identify formal job training that relates to this position:
Identify what skills or certifications you possess related to this position:
If hired, what value would you bring to our municipality?
Describe what you believe are the most unique features of your work history:
Have you ever been employed with this municipality before?
Yes
No
When?
Do you have any friends or relatives employed by this municipality?
Yes
No
Please provide their names and relationship to you:
Are you currently employed?
Yes
No
May we contact your employer?
Yes
No
Are you currently on “lay off” status and subject to recall?
Yes
No
If you are under 18 years of age, can you provide proof of your eligibility to work?
Yes
No
If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.?
Yes
No
Do you or will you in the future require sponsorship for employment visa status (e.g. H-1B visa status)?
Yes
No
Are you able to perform all of the essential functions of the job for which you are applying with or without reasonable accommodation?
Yes
No
Do you have a valid driver’s license?
Yes
No
N/A
If driving is a requirement of the position applied for, have you in the last 7 years been convicted of Driving Under the Influence “(DUI)”?
Yes
No
If hired, do you have a reliable means of transportation to and from work?
Yes
No
If hired, would you be able to travel or work overtime or weekends as needed?
Yes
No
Have you ever, under your name or another name, been convicted off (or pleaded no contest to) a felony or misdemeanor?
Yes
No
Have you ever, under your name or another name, been convicted of a crime, which resulted in your being in prison and/or jail and released from prison and/or jail or paroled?
Yes
No
Please fully explain when, where and of what you were convicted and the result of the case(s).
Are you currently under arrest, or released on bond on your own recognizance, pending trial for a criminal offense?
Yes
No
Please state the nature of the crime charged, and when and where the trial is pending.
Name
Relationship & Years Acquainted
Company Name
Occupation
Email
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