Fillable 321 Zoar Road dmin@rowe-ma.gov P.O. Box 462 -339-5520 (Town of Rowe)

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321 Zoar Road dmin@rowe-ma.gov P.O. Box 462 -339-5520 (Town of Rowe)

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Town of Rowe – Employment Application – v. 06/12/2020
EMPLOYMENT APPLICATION
Posit
ion Applied For: __________________________________ Date of Application: ____________________
Name: _______________________________________________________
Last, First, Middle Initial
Mailing
Address: _____________________________________ ___________________ ______ __________
Town
State
Zip
Telephone Number: _________________
Email: _________________________________________
Have You Previously Been Employed By the Town of Rowe? Yes No
If Yes: __________________ /_________
_________________________________________
Month/Year (Most Recent Employment)
Position (Most Recent Employment)
Person to Be Notified In Case Of Emergency:
Name: _____________________________________________ Telephone Number: ________________
Address:__________________________________________________________________________________________
Personal Information:
Are You a United States Citizen? Yes No Highest Grade Level Completed: _________________________
Awards and Honors:
Special Training:
Military Service Record:
Branc
h: _________________ Date of Discharge: _______________ Reserve Status: Active Inactive
Rese
rve Rank: _________________ Was Discharge Other Than Honorable? ______________________
Driver’s License Information:
Do You Have A Valid Driver’s License? Yes No If Yes, From What State? ________________________
Do You Have A Clean Driving Record? Yes No If No, Please Explain: ___________________________
Do You Have Valid Automobile Insurance? Yes No Company Name: _______________________________
321 Zoar Road
P.O. Box 462
Rowe, Massachusetts 01367
E-mail: a
dmin@rowe-ma.gov
Phone: 413
-339-5520 x11
Fax: 413-339-5316
Town of Rowe
Street or P.O. Box
Select From List
Select Month
2010
Town of Rowe – Employment Application – v. 06/12/2020
Employment References
Employment History
List Present or Last Employer First
Name
Address
Dates of
Employment
(Month & Year)
Position Held
Hourly
Rate
Reason For
Leaving
From: ____________
To: ____________
From: ____________
To: ____________
From: ____________
To: ____________
Other Job Experience and/or Qualifications You May Wish To List:
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.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment
relationship with the Town of Rowe is of an “at will” nature, which means that the Employee may resign at
any time and the Employer may discharge Employee at any time with or without cause. It is further
understood that this “at will” employment relationship may not be changed by any written document or by
conduct unless such change is specifically acknowledged in writing by the Town of Rowe. In the event of
employment, I understand that false or misleading information given in my application of interview(s) may
result in discharge. I understand, also, that I am required to abide by all rules and regulations of the
employer.
S
ignature: _________________________________________ Date: ____________________
P
rinted Name: _________________________________________
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321 Zoar Road dmin@rowe-ma.gov P.O. Box 462 -339-5520 (Town of Rowe)

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Completed 16 July 2020

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