Town of Middlebury Application for Employment
What position are you applying for?
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Please Select
Public Works Department
Parks Department
Wastewater Department
Water Department
Administrative Assistant
Accounts Payable
Utility Billing Clerk
Utility Locator
Date of application
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Month
-
Day
Year
Date
Name
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First Name
Middle Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
If you are under 18 years of age, can you provide required proof of your eligibility to work?
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Please Select
Yes
No
I am over 18 years of age
Have you ever filed an application with us before?
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Please Select
Yes
No
Have you ever been employed with us before?
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Please Select
Yes
No
If yes, please provide your previous employment date.
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Month
-
Day
Year
Date
Are you currently employed?
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Please Select
Yes
No
May we contact your present employer?
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Please Select
Yes
No
On what date would you be available to start working?
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-
Month
-
Day
Year
Date
What type of employment are you seeking?
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Please Select
Full Time
Part Time
Temporary
Are you currently on "lay-off" status and subject to recall?
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Please Select
Yes
No
Can you travel if a job requires it?
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Please Select
Yes
No
Have you been convicted of a felony within the last 7 years?
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Please Select
Yes
No
If you answered "Yes" to the previous question, please explain.
Education
Did you receive a High School Diploma or GED?
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High School Diploma
GED
Neither
What is your highest level of education? (please select a grade level)
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Please Select
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
1 Year of College
2 Years of College
3 Years of College
4 Years of College
List the name of the High School you attended:
List the address of the High School you attended:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
List the name of the College or University you attended:
List the address of the College or University you attended:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Indicate any foreign languages are fluent in and whether you can speak, read, or write in this language:
Describe any specialized training, apprenticeship, skills and extra-curricular activities:
Employment Experience
Start with your present or most recent job. Include any job-related military service assignment and volunteer activities.
Employment Experience 1:
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Employment Experience 2:
Employment Experience 3:
Employment Experience 4:
Employment Experience 5:
Additional Information
List professional, trade, business or civil activities and offices held.
Other Qualifications: Summarize special job-related skills and qualifications acquired from employment or other experience.
Select any specialized skills you obtain:
Computer
Calculator
Fax
Production
Mobile Machinery
Computer Programs
Other
List any "Other" specialized skills you obtain:
Provide details about your specialized skills:
State any additional information you feel may be helpful in considering your application:
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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?
Please Select
Yes
No
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
References
Reference 1:
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Reference 2:
Reference 3:
Reference 4:
Date of Submission:
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Month
-
Day
Year
Date
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.
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Submit
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