Town of Pulaski Employment Application

  Application for Employment with the Town of Pulaski

  Personal Information

NAME (LAST NAME FIRST)

 

PHYSICAL ADDRESS

      

CITY

      

STATE

      

ZIP CODE

      

PERMANENT ADDRESS

      

CITY

      

STATE

      

ZIP CODE

      

E-MAIL ADDRESS

      

 

 

PHONE NUMBER

     

 

SECONDARY PHONE NUMBER

     

 

REFERRED BY

 

      

 

 

 

  Employment Desired

POSITION

DATE YOU CAN START

 

ARE YOU EMPLOYED NOW?


 Yes  No

IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?

 

Yes  No

ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?

 

Yes  No

EVER APPLIED TO THE TOWN OF PULASKI BEFORE?

Yes  No

WHERE

WHEN

EVER WORKED FOR THE TOWN OF PULASKI BEFORE?

Yes  No

WHERE

WHEN

REASON FOR LEAVING

NAME OF LAST SUPERVISOR AT THIS COMPANY

HOW DID YOU FIND OUT ABOUT THIS POSITION?

 

 

 

 

 

 

  Education History

 

NAME & LOCATION OF SCHOOL

YEARS ATTENDED

DID YOU GRADUATE?

SUBJECTS STUDIED

HIGH SCHOOL

Yes  No

COLLEGE

Yes  No

TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL

Yes  No

 

 

  General Information

SUBJECT OF SPECIAL STUDY/RESEARCH WORK

SPECIAL TRAINING, CERTIFICATIONS, LICENSES

SPECIAL SKILLS, FOREIGN LANGUAGES, ETC.

 

  Military Service Record

HAVE YOU EVER SERVED IN THE U.S. ARMED FORCES?

Yes  No

BRANCH OF SERVICE

DISCHARGE DATE

RANK

 

 

 

  Former Employers (List below last three employers, starting with most recent)

NAME OF PRESENT OR LAST EMPLOYER

ADDRESS

CITY

STATE

ZIP CODE

STARTING DATE

LEAVING DATE

JOB TITLE

MAY WE CONTACT YOUR SUPERVISOR?

Yes No  

NAME OF SUPERVISOR

TITLE

PHONE

DESCRIPTION OF WORK

REASON FOR LEAVING

 

  NAME OF PREVIOUS EMPLOYER

ADDRESS

CITY

STATE

ZIP CODE

STARTING DATE

LEAVING DATE

JOB TITLE

MAY WE CONTACT YOUR SUPERVISOR?

Yes  No

NAME OF SUPERVISOR

TITLE

PHONE

DESCRIPTION OF WORK

REASON FOR LEAVING

 

  NAME OF PREVIOUS EMPLOYER

ADDRESS

CITY

STATE

ZIP CODE

STARTING DATE

LEAVING DATE

JOB TITLE

 

MAY WE CONTACT YOUR SUPERVISOR?

Yes  No

NAME OF SUPERVISOR

TITLE

PHONE

DESCRIPTION OF WORK

REASON FOR LEAVING

 

 

  References(List professional references whom we may contact)

NAME

ADDRESS

BUSINESS

PHONE

 

 

 

 

Authorization

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.”

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

 

                          

 Date                              Electronic Signature (if available)      

 
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