Employment Application

Town of Mountainair

Application for Employment
Full Legal Name*

First NameMiddle NameLast Name
Address*

Street Address

PO Box #

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
E-mail*
Referral

First NameLast Name
Check one *

I am looking for Full time workI am Looking for Part time workI am Looking for Temporary workI am Looking for Seasonal work
Desired Salary Range*
Position Applied for*
Date Available for Work*

MonthDayYear
Date
Have you ever been employed by the Town of Mountainair?*

YesNo
If yes, when:
Does the Town of Mountainair employ any relative of yours?*

YesNo
If yes, Name:
Relationship:
Can you work legally in the United States?

YesNo
If hired, documentation showing eligibility for employment and identity will be requested.
Do you possess a valid driver's license?*

YesNo
State and License #*
Class
Have you ever been convicted of a misdemeanor or felony?*

YesNo
* A conviction will not necessarily disqualify applicant from employment.
If yes, please give date(s) and place(s), the specific charge(s) and fully explain the situation.
U.S. Military Service:*

YesNo
Date Entered

MonthDayYear
Date
Branch & Rank

BranchRank
Date Discharged

MonthDayYear
Date
Is this application a request for re-employment following an extended military leave of absence from the Town: :

YesNo
Education History
High School
High School Name
High School City, State
Level Completed

Not graduatedHS DiplomaGED
College Name
College Name
Degree Obtained
City, State
Graduate School
Graduate School
Degree Obtained
City, State
Special Skills, Certificates or Licenses
Examples : Typing Speed, Software Programs, Office Machines, Heavy Equipment, Foreign Languages Known (Fluent), CPR / First Aid / EMT-B / Other, Other Special Skills
Please indicate any other information you would like us to consider:
Employment History
Employer 1*
Type of business*
Most Recent Employer Address*

Street Address

Street Address Line 2

CityState / Province

Phone numberCountry
Starting Pay*
Ending Pay*
Hours worked
*

Rows Date Started Date Ended

Dates worked for
Type of work performed*
Reason for Leaving*
Supervisors Name and Position *

NamePosition
May We contact*

YesNo
Employer 2 Name
Type of business
Second Recent Employer Address

Street Address

Street Address Line 2

CityState / Province

Phone numberCountry
Starting Pay
Ending Pay
Hours worked
Type a question

Rows Date Started Date Ended

Dates worked for
Type of work performed
Reason for Leaving
Supervisors Name and Position

NamePosition
May We contact

YesNo
Employer 3 Name
Type of business
Employer Address

Street Address

Street Address Line 2

CityState / Province

Phone numberCountry
Starting Pay
Ending Pay
Hours worked
Type a question

Rows Date Started Date Ended

Dates worked for
Type of work performed
Reason for Leaving
Supervisors Name and Position

NamePosition
May We contact

YesNo
Employer 4 Name
Type of business
Employer Address

Street Address

Street Address Line 2

CityState / Province

Phone numberCountry
Starting Pay
Ending Pay
Hours worked
Rows Date Started Date Ended

Dates worked for
Type of work performed
Reason for Leaving
Supervisors Name and Position

NamePosition
May We contact

YesNo
References

Personal or Professional
Reference 1*

Name

Title

Relationship Phone Number

Years Known
Reference 2*

Name

Title

Relationship Phone Number

Years Known
Reference 3*

Name

Title

Relationship Phone Number

Years Known
At this point in the application you are free to tell us what makes you the perfect candidate for Town of Mountainair, if you desire.
Feel Free to upload your Resume

Upload a File

Cancelof
I certify that all information I have provided in order to apply for and secure work with the Town of Mountainair is true, complete and correct.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to eliminate me
from further consideration for employment, or may result in my immediate discharge from employment, whenever it is discovered. I understand that by signing
this, I give the Town of Mountainair permission for a background check and drug test at their discretion.
Signature of Applicant Date
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. By signing, you certify you have read, understand and accept terms.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Rows	Date Started	Date Ended
Dates worked for

Rows	Date Started	Date Ended
Dates worked for

Rows	Date Started	Date Ended
Dates worked for

Rows	Date Started	Date Ended
Dates worked for

Town of Mountainair

Education History

High School

College Name

Graduate School

Special Skills, Certificates or Licenses

Employment History

References