Employment Application

Town of Middlebury Application for Employment
What position are you applying for?
Date of application

MonthDayYear
Date
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
If you are under 18 years of age, can you provide required proof of your eligibility to work?
Have you ever filed an application with us before?
Have you ever been employed with us before?
If yes, please provide your previous employment date.

MonthDayYear
Date
Are you currently employed?
May we contact your present employer?
On what date would you be available to start working?

MonthDayYear
Date
What type of employment are you seeking?
Are you currently on "lay-off" status and subject to recall?
Can you travel if a job requires it?
Have you been convicted of a felony within the last 7 years?
If you answered "Yes" to the previous question, please explain.
Education
Did you receive a High School Diploma or GED?
What is your highest level of education? (please select a grade level)
List the name of the High School you attended:
List the address of the High School you attended:

Street Address

Street Address Line 2

CityState / 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

CityState / 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:
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:

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:
Upload your resume

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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?
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:
Reference 2:
Reference 3:
Reference 4:
Date of Submission:

MonthDayYear
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.
Should be Empty:

Town of Middlebury Application for Employment

Education

Employment Experience

Additional Information

References