Fillable 144 City of Claremont

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144 City of Claremont

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Country of origin: US
File type: PDF

U.S.A. forms for Town of Bow, NH

BROWSE TOWN OF BOW, NH (NH) FORMS

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1
Finance Department
10 Grandview Road
Bow, NH 03304
Application for Employment
Please Print (in blue or black ink) or Type
Date: Name:
PERSONAL
Position(s) applied for:
Availability: Full-time Part-time Seasonal
Full Name: Social Security # (Optional):
Street Address:
Mailing Address:
Work Phone: ( )
City: State: Zip:
Have you ever been employed with us before? NO
YES (if yes, provide details here↓)
Title of position held: Termination Date:
Reasons for leaving:
List any relative who currently works for the Town of Bow:
Name Department Relationship
If you are under 18 years of age, can you
Provide required proof of your eligibility to work? Yes No
Are you a citizen of the United States? Yes No
If no, can you provide proof that you are eligible to work in the United States, in
accordance with the Immigration Reform and Control Act? Yes No
Did you receive a high school diploma or GED? Yes No
Highest grade complete: College:
School (name, city, state) Dates Degree Major/Minor
High School From:
To:
Undergraduate From:
College/University To:
Graduate/Professional From:
College/University To:
Other Education From:
i.e. Technical, Business To:
EDUCATION
Home Phone: ( )
EMAIL
PRINT
✔
Town of Bow
2
CRIMINAL HISTORY
Have you ever been arrested for or convicted of a crime that has not been annulled by a court?
No Yes
If yes, explain fully (Conviction will not automatically disqualify you from employment).
(use additional sheets if necessary)
Have you ever served in the U.S. Armed Forces? Yes No
If yes, what branch?
Type of discharge? Rank at discharge:
Describe any training received which would be relevant to the position you are applying:
SPECIAL SKILLS
List technical / professional licenses or certifications you hold:
List office machines and other equipment you can operate:
Indicate any specialized training you have received:
DRIVING HISTORY (use additional sheets as necessary)
List specialized vehicles that you can operate:
List ALL presently unexpired motor vehicle operator’s licenses you hold:
License #:
Issuing State: Expires: Type:
License #:
Issuing State: Expires: Type:
Date of Birth:
(Necessary to conduct motor vehicle records check.)
Provide complete motor vehicle accident record for past 7 years.
Dates Nature of Accident (head-on, rear-end, etc.)
Last Accident:
Next previous:
Next previous:
Indicate ALL traffic convictions during the past 7 years (other than parking violations) and dates of ALL license suspensions or
forfeitures during the past 7 years
Location Date Description
MILITARY
✔
3
EMPLOYMENT HISTORY
(List most recent employer first. Please account for any gaps in employment record.)
Company: Your Title:
Street Address: Employed From:
City, State, Zip: Employed To:
May we contact Yes
Salary or Starting:___________ Per________________________
This employer? No
Rate of Pay Ending: ___________ Per________________________
Responsibilities:
Supervisor’s name: Phone No.:
Reason for leaving:
Company: Your Title:
Street Address: Employed From:
City, State, Zip: Employed To:
May we contact Yes
Salary or Starting:___________ Per________________________
this employer? No
Rate of Pay Ending: ___________ Per________________________
Responsibilities:
Supervisor’s name: Phone No.:
Reason for leaving:
Company: Your Title:
Street Address: Employed From:
City, State, Zip: Employed To:
May we contact Yes Salary or
Starting:___________ Per________________________
this employer? No Rate of Pay
Ending: ___________ Per________________________
Responsibilities:
Supervisor’s name: Phone No.:
Reason for leaving:
Company: Your Title:
Street Address: Employed From:
City, State, Zip: Employed To:
May we contact Yes Salary or
Starting:___________ Per________________________
this employer? No Rate of Pay
Ending: ___________ Per________________________
Responsibilities:
Supervisor’s name: Phone No.:
Reason for leaving:
If needed, please attach additional sheets to include additional employment
4
REFERENCES (list 3 professional references)
Name & Occupation Address Phone Relationship
MISCELLANEOUS ADDITIONAL INFORMATION
Have you ever applied for a position with us before? Yes No
If yes, give date and the position:
Use this space for further information you think would help us evaluate your application.
APPLICANT'S STATEMENT
(Please read carefully before signing)
*Digital Signature (type full name and check agree) Date (enter today's date)
I agree
I authorize the Town of Bow to obtain any information from schools, residential management agents, employers, criminal justice
agencies or individuals relating to my activities. This information may include but is not limited to academics, residential, achievements,
performance, attendance, personal history, disciplinary, arrest and convictions records (both juvenile and adult). Further, I hereby
authorize all references, persons, schools, my current employer (if applicable), and previous employers and organizations named in this
application (and accompanying resume and other documentation supplied to me, if any) to provide the Town of Bow any relevant
information that may be required to arrive at an employment decision. I understand that the information release is for the Town
of Bow's use only.
In submitting this application for consideration and as indicated by my signature below, I hereby certify that all responses provided
herein and throughout the application process are true and complete to the best of my knowledge. I authorize the Town of Bow
and/or its authorized agent(s) to investigate my personal and employment history and financial and credit record. I further authorize
investigation of all statements contained in this application for employment as may be deemed necessary in arriving at an employment
decision. I understand that should an investigation at any time disclose any misrepresentations and/or falsifications as stated herein,
upon any other employment-related forms or made during an interview(s), my application will be rejected and should I become or already
be employed with the Town of Bow, my employment may be terminated.
I understand that if I am employed by the Town of Bow, I am required to become familiar with and abide by all rules and regulations
of the Town of Bow as established and amended from time to time. I understand and acknowledge that, unless otherwise defined
by applicable law, any employment relationship established with the Town of Bow is of an "at will" nature, which means that the
employee may resign at any time and the Town of Bow may discharge the employee at any time with or without cause. I further
understand that this "at will" employment relationship may not be changed by any written instrument or by conduct unless such change
is specifically acknowledged in writing by an authorized representative of the Town of Bow.
I release any individual, including record custodians, from any and all liabilities for damages of whatever kind or nature which may, at
any time happen to me as a result of compliance, or any attempts to comply with this authorization.
I understand that I may be required to sign a facsimile of this form before I may begin employment in this or any other position.
By checking the box below, you are certifying that you have read and agreed to the above statement.*
ORIGINAL SIGNATURE AND DATE IS REQUIRED UPON HIRE
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144 City of Claremont

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Completed 11 July 2020

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