Fillable 337 - Employment_ApplicationFINAL

Fill Online, Printable, Fillable, Blank 337 - Employment_ApplicationFINAL Form

Use Fill to complete blank online TOWN OF BEDFORD (VA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

337 - Employment_ApplicationFINAL

On average this form takes 52 minutes to complete

The 337 - Employment_ApplicationFINAL form is 8 pages long and contains:

  • 2 signatures
  • 38 check-boxes
  • 183 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Bedford

BROWSE TOWN OF BEDFORD (VA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Open Position applying for:
(An application must be submitted for each position)
APPLICATION FOR EMPLOYMENT
Town
of Bedford 215 E. Main Street
Bedford, Virginia 24523
Town of Bedford Website: www.bedfordva.gov
INSTRUCTIONS
Please read and follow directions carefully
The Town of Bedford only accepts applications and resumes for current openings. Openings are posted on
the Town Website and at the Town Municipal Building, 215 East Main Street, Bedford, Virginia, on Bedford
Government Information Channel 12 and the Virginia Employment Commission.
Your application should include the following inserts: (In order for your application to be considered for
employment with the Town of Bedford, both forms must be submitted with each application).
Fair Credit Reporting Act Disclosure Form
Fair Credit Reporting Act Acknowledgement and Consent Form
Fully complete all sections of the application. A supplemental form for additional employment history is
available.
The completeness and appearance of your application will be considered in the selection process and
therefore should represent your best effort.
A separate original application for each position for which you apply is preferred. However, a copy of the
application may be submitted if applying for more than one position.
Applications that are received unsigned, or after the closing date, will not be processed.
Applications, resumes, letters of reference and other information submitted will become the property of the
Town and will not be returned.
Residency in the Town of Bedford may be required for certain positions.
In order to learn the most effective way of informing interested persons of the job opportunities with the Town of
Bedford, please check below how you learned of the job opening with the Town.
Town of Bedford Website: From a Town Employee: Cable TV (Channel 12):
Virginia Employment Commission:
Newspaper (Name of Newspaper):
Other (please specify):
Number of Attachments:
Town of Bedford, Virginia
Application for Employment
An Equal Opportunity Employer
Open Position applying for:
(An application must be submitted for each position)
PERSONAL INFORMATION: Social
Security
NAME: Number:
First Middle Last
Present address: ___________________________________________________________________________________
Street City State Zip Code
Previous address:
Street City State Zip Code
Phone number (Day):____________________________________ (Evening): ___________________________________
Are you a current employee or have you worked for the Town of Bedford in the past? Yes No If yes, when _________
Your name when employed (if different): __________________________________________________________________
Do you have a valid driver's license? Yes No CDL? Yes No Endorsements (if any): __________________
Expiration date: ____________________________________________________ Issuing state: _____________________
Have you ever been convicted of a: Felony Yes No b: Misdemeanor Yes No
If yes, please explain:
Any traffic infractions (moving violations) Yes No If yes, please explain and give dates: _______________________
(A conviction or violation does not automatically eliminate you from employment consideration. The nature of the
offense, when it occurred and the requirements of the position will be taken into consideration.)
Have you ever been fired or asked to resign from a job? Yes No
If yes, give date(s), name and address of employer, and reason (attach additional sheets if necessary): _______________
(A firing or forced resignation does not automatically eliminate you from employment consideration. The circumstances, time elapsed, and
employment record may be considered.)
Failure to be completely truthful and accurate may cause you to be disqualified from employment consideration
or result in termination if discovered after employment.
EDUCATION:
Do you have a High School Diploma? Yes No GED? Yes No
School name and address: _______________________________________________________________________
ADDITIONAL EDUCATION:
Name and Address
Number of
Years
completed
Degree Completed
(BA, BS, MA, etc., or certificate)
Field(s) of Study
College
Graduate Work
Other (i.e., business, secretarial,
vocational, technical, military, etc.)
Please list any special skills, qualifications, professional memberships or other matters that you believe qualify you for
the position you are seeking. (Do not disclose membership in organizations that do not relate to the position you are
seeking.)
REFERENCES:
List names and contact information for three people that know your qualifications. Incomplete information could
affect your consideration.
Name and Occupation Company City and State Phone # (include Area Code)
1.
2.
3.
WORK HISTORY:
Give a complete record of your employment history including part-time work, military service, and volunteer
experience. List all experience in order, starting with your present or most recent position and working back. Describe
your duties and responsibilities in each position so that your experience may be thoroughly and fairly evaluated. Use
supplementary Experience Form for additional space. Account for all periods of unemployment.
May we contact your present employer? Yes No
Name of Employer and Mailing address
(including zip code)
Job Title:
Dates Worked: To:
Full-time Part-time
Employer Telephone Number (including area code)
Name and title of your immediate supervisor:
Starting Final
Salary: Salary:
Number of people you supervised:
Reason for leaving:
Description of duties:
Name of Employer and Mailing address
(including zip code)
Job Title:
Dates Worked: To:
Full-time Part-time
Employer Telephone Number (including area
code)
Name and title of your immediate supervisor:
Starting Final
Salary:
Salary:
Number of people you supervised:
Reason for leaving:
Description of duties:
Name of Employer and Mailing address
(including zip code)
Job Title:
Dates Worked: To:
Full-time Part-time
Employer Telephone Number (including area
code)
Name and title of your immediate supervisor:
Starting Final
Salary:
Salary:
Number of people you supervised:
Reason for leaving:
Descrip
tion of duties:
List the equipment, computers, software, etc. you have used in previous jobs:
WPM:
Certification- Each application requires current date and original signature
I hereby certify that all entries on the application and attachments to the application are true and complete. I understand that any willful misstatements
or material omissions in this application or attachments will be sufficient cause to disqualify me from employment consideration with the Town of
Bedford. I agree and understand that any misstatements or omissions, regardless of time of discovery, may be considered grounds for dismissal. I
understand that this completed application and any materials submitted with it are the property of the Town of Bedford and will not be returned. In the
case of a panel interview, which may consist of non-Town employees, I authorize my application to be viewed by members of the panel. I also
understand that any offer of employment is contingent upon my ability to produce documentation as required by law to confirm that I am eligible for
employment in the United States.
I understand that all information on this application is subject to verification. I consent to background checks that may include contacting references,
former employers and educational institutions listed being contacted regarding this application.
I further authorize the Town of Bedford to rely upon and use, as it sees fit, any information received from such contacts. Information contained on this
application may be disseminated to other agencies, non-governmental organizations or systems on a need-to-know basis for good cause shown as
determined by the agency head or designee.
I authorize the release of any and all job-related information that the Town of Bedford may request or any records pertaining to past or present
employment which may now exist or may exist in the future.
Signature: Date:
click to sign
signature
click to edit
SUPPLEMENTAL SHEET
Name of Employer and Mailing address
(including zip code)
Job Title:
Dates Worked: To:
Full-time Part-time
Employer Telephone Number (including area code)
Name and title of your immediate supervisor:
Starting Final
Salary:
Salary:
Number of people you supervised: Reason for leaving:
Description of duties:
Name of Employer and Mailing address
(including zip code)
Job Title:
Dates Worked: To:
Full-time Part-time
Employer Telephone Number (including area code)
Name and title of your immediate supervisor:
Starting Final
Salary:
Salary:
Number of people you supervised:
Reason for leaving:
Description of duties:
Name of Employer and Mailing address
(including zip code)
Job Title:
Dates Worked: To:
Full-time Part-time
Employer Telephone Number (including area code)
Name and title of your immediate supervisor:
Starting Final
Salary:
Salary:
Number of people you supervised: Reason for leaving:
Description of duties:
FAIR CREDIT REPORTING ACT DISCLOSURE
By this document, the Town of Bedford discloses to you that a consumer report may be
obtained for employment purposes as part of the pre-employment background investigation and at
any time during your employment. This disclosure is required by the Fair Credit Reporting Act. Please
sign below to signify that you have reviewed this disclosure.
Full Name
(Please Print):
Signed:
Date:
FAIR CREDIT REPORTING ACT ACKNOWLEDGEMENT AND CONSENT
I acknowledge that I have reviewed a clear and conspicuous Fair Credit Reporting Act Disclosure form. I understand
that the Town of Bedford may obtain consumer reports about me for employment purposes from a consumer
reporting agency. I understand and authorize the consumer reporting agency to verify my past and present driving
records, education records, credit history, and professional credentials. I further authorize the consumer reporting
agency contracted by the Town to perform a criminal records search. I also understand that:
The Town of Bedford may use consumer reports to evaluate me for employment, and, if I am hired, may use
consumer reports to evaluate me for other employment purposes.
The Town of Bedford may not obtain a consumer report about me for employment purposes without my
written authorization.
Before the Town of Bedford denies me employment or makes any other employment decision which
adversely affects me based in whole or in part on a consumer report, the Town of Bedford must first
provide me with a copy of the report and a summary of my rights under the Fair Credit Reporting Act.
The Town of Bedford considers consumer reports to be important tools in its personnel administration,
audit and security practices. My failure to authorize the Town of Bedford to obtain a consumer report about
me may serve as grounds for the Town of Bedford to refuse to hire me. My revocation of such authority
may serve as grounds for the Town of Bedford to dismiss me from its employment.
I authorize the Town of Bedford and its agents, affiliates, or assign to obtain one or more consumer reports about me for
employment purposes at any time they may deem appropriate. I understand that the consumer reporting agency does
not guarantee the accuracy or timeliness of the information obtained from other third party sources. This is a continuing
authorization that shall remain in effect until I revoke it in writing.
Name Maiden (?)
Last First Middle
Date of Birth: (Only used for record confirmation)
Social Security Number
Current Address: ________________________________________ How long?
City, State, Zip:________________________________________________________________
Previous Address________________________________ How long? _________
City, State, Zip _____________________________________________________
Driver's License # and State issued:
Please list all other names that information may be listed under:
Signed: _____________________________________________________ Date:
California, Minnesota & Oklahoma residents only: I want to receive a free copy of any Consumer Report, Investigative Consumer
Report or Credit Report on me that is requested. Yes No
For GA Criminal Searches Only (Must Check One): Employment w/ Mentally Disabled (Purpose Code M)
Employment w/ Elder Care (Purpose Code N)
Employment w/ Children (Purpose Code W) None Apply
PO Box26140
Greensboro, NC 27402
(800) 449-0254 www.firstpointresources.com
04-2013
Fax: 800-888-3487
NAME (First, Middle, Last)__________________________________________________________Gender Male / Female
MAIDEN NAME (If applicable)_________________________________________________________________________
CURRENT ADDRESS: ________________________________________________HOW LONG?____________________
CITY, STATE, ZIP: __________________________________________________________________________________
1
ST
PREVIOUS ADDRESS_____________________________________________HOW LONG?____________________
CITY, STATE, ZIP: __________________________________________________________________________________
APPLICANT SOCIAL SECURITY NUMBER: ___________-_________-__________ DATE OF BIRTH____/_____/____
DRIVER’S LICENSE # AND STATE ISSUED: ____________________________________________________________
APPLICANT AUTHORIZATION
I hereby authorize FirstPoint, Inc. (“FirstPoint”) to prepare an INSIGHT report that will include my present and previous
employment information including salary as well as work performance. I also authorize FirstPoint to verify my past and present
driving records, education records, credit history, and professional credentials. I further authorize FirstPoint to perform a criminal
records search.
Further, I authorize my current and former employers, as well as other organizations to provide such information to FirstPoint.
New York employers and residents only:
By signing this consent form I acknowledge receipt of a copy of Article 23-A of New York Corrections Law.
CONSUMER DISCLOSURE
I understand that a pre-employment consumer report (Insight) may be obtained from the FirstPoint, Inc for employment purposes.
______________________________________________________ ______ / ______ / _______
APPLICANT’S SIGNATURE DATE
California, Minnesota & Oklahoma residents only:
I want to receive a free copy of any Consumer Report, Investigative Consumer Report or Credit Report on me that is requested.
Yes No
For GA Criminal Searches Only (Must Check One): Employment w/ Mentally Disabled (Purpose Code M)
Employment w/ Elder Care (Purpose Code N) Employment w/ Children (Purpose Code W) None Apply
Town of Bedford Requester ______________________
CLIENT ID#: INS_00902
Criminal records search States to be searched? _______________________________________________
Credit Report (Persona) Multi-State Criminal Index w/Sex Offender Registry
Motor Vehicle Record SS number & Name Verification /Address search
Verification Services (Employment, Education, and Professional License) please list schools or employers below:
Verification list here: __________________________________________________________________________________
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

337 - Employment_ApplicationFINAL

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 11 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document