3/7/2019
APPLICATION FOR
EMPLOYMENT
TOWN OF MILTON, VT
The Town of Milton considers applicants for all positions without regard to race, color, religion, creed, gender, national
origin,
age, disability, marital or veteran status, sexual orientation, or any other legally protected status. Before you submit
your
application, make sure all sections of the application have been completed and that all information requested has
been
provided. At the sole discretion of the Town Manager, incomplete applications may not be
considered.
PLEASE PRINT
Position Applying for:
(Submit a separate application for each position applying
for)
How did you hear about us? Advertisement Website Walk-In _Friend/Relative Other
PERSONAL
Name (First, Middle, Last):
Have you been known by any other name (if applicable)?
Address:
Town/City/State and Zip Code:
Phone Number(s) (where we may contact you):
E-mail address:
GENERAL INFORMATION
If you are under 18 years of age, can you provide required proof of your eligibility to work? No Yes
Have you ever filed an application with us before?
Have you ever been employed with us before?
Are you currently employed?
If so, may we contact your employer for references?
Can you be lawfully employed in the USA?
No Yes-Approximate Date: _
No Yes-Approximate Date: _
No Yes
No Yes
No Yes
On what date are you available to work?
Are you available to work: Full time Part time Shift work Temporary/Seasonal Volunteer
Are you currently on layoff status, subject to recall?
Can you travel if a job requires it?
Do you require any type of special accommodation?
No Yes
No Yes
No Yes
If so, please explain: (use separate sheet if necessary)
3/7/2019
Do you currently have a legal/valid license to operator a motor vehicle?
No Yes
Type of CDL License (if applicable)
Has your license ever been suspended? No Yes
If yes, when and why?
Can you comply with our Workplace Non-Smoking Policy?
No Yes
Do you, or have you used illegal drugs?
No Yes
If yes, explain
Has action ever been taken against any professional license/certification that you have held? No Yes
If yes, please explain: (use separate sheet if necessary)
Have you ever been disciplined in any way for alcohol and/or drug use on a job?
No Yes
If yes, please explain: (use separate sheet if necessary)
Have you ever been discharged or asked to resign from any employment?
No Yes
If yes, please explain: (use separate sheet if necessary)
EDUCATION
Name & Location of School Course of Study # Years Completed Diploma/Degree
Are you a veteran of service in the United States Armed Forces?
If so, were you honorably discharged?
No Yes
No Yes
From what Branch:
Date of discharge:
List job-related training received in the US Military:
List
Specialized training, apprenticeship, and skills:
List
Professional, trade, business or civil activities/offices held:
List
Describe any specialized training, apprenticeships, licenses, or skills, which you believe should be
considered in evaluating your qualifications for employment (It is not necessary to include information
which indicates race, color, National origin or other protected status.)
3/7/2019
ADDITIONAL EXPERIENCE OR QUALIFICATIONS
Computer/Technical Skills (Check skills and level of proficiency):
Type Name of Program Years Used Beginner Intermediate
Advan
ced
Windows
Spreadsheet
Word Processing
Data Entry
Other
Other
Telephone (# of Extensions)
Typing
(WPM)
State any additional information you feel may be helpful to us in considering your application:
REFERENCES Please list 3 Personal References and 3 Professional References
PERSONAL
Name Address Phone
PROFESSIONAL
Name Address Phone
3/7/2019
EMPLOYMENT EXPERIENCE Start with your present or last job, please explain gaps in any employment.
NOTE: If you write see resume, be sure ALL requested information is there or your application may be
denied. Specifically reason for leaving and may we contact employer.
1. Employer Name and Address
Job Title, Employment Dates (from and to)
Supervisor Name, Title and Telephone Number
Describe Work Performed
May
we
contact
this
employer as a reference? ___ No Yes
Reason for Leaving
2. Employer Name and Address
Job Title, Employment Dates (from and to)
Supervisor and Telephone Number
Describe Work Performed
May
we
contact
this
employer as a reference? ___ No Yes
Reason for Leaving
3. Employer Name and Address
Job Title, Employment Dates (from and to)
Supervisor and Telephone Number
Describe Work Performed
May
we
contact
this
employer as a reference
?
___ No Yes
Reason for Leaving
3/7/2019
APPLICANTS STATEMENT Read Carefully Before Signing
I hereby state the information I provided in this application and any supporting information i.e. my
resume, is true and accurate to the best of my knowledge. I authorize verification of any or all of the
information and any inquiries permissible by law to determine my suitability for employment.
I hereby understand and acknowledge that, should the Town of Milton employ me I am entering an At-
Will employment relationship and may resign or be terminated at any time with or without cause or reason
and with or without prior notice. It is further understood this At Willemployment relationship may not
be changed by any written document or by conduct unless such change is specifically acknowledged in
writing by the Milton Town Manager. Subject to applicable provisions of the Town of Milton
Administrative Code or a Town of Milton Collective Bargaining Agreement.
In the event of employment, I understand that false or misleading information given in this application
and/or interview(s) may result in discharge. I understand I am required to abide by all rules and
regulations of the Town of Milton.
I verify I have fully read this application to the best of my ability and have not left any questions
and/or sections blank:
Signature:
Date:
Please submit your application to:
John Bartlett, Director of Administration, Facilities & HR
43 Bombardier Road
Milton, VT 05468
jbartlett@miltonvt.gov
Telephone: 802-891-8049 ~ Fax: 802-891-8098 ~ Town Website: www.miltonvt.gov
INTERVIEW PROCESS
Once a sufficient number of applications have been received they will be reviewed to determine who will
be interviewed. This process may take several weeks.
Should we contact you for an interview, please be aware that we follow a careful, team based approach to
hiring. Our interview process usually consists of two interviews to give participants a real sense of our
organization and what is required of them.
Once interviews are completed, we (and you) want to make sure we have determined who will be the best
candidate to join our Team.
We will contact you if we are interested in your application. Please refrain from repeated phone calls to
inquire as to the status of your application.
Thank you for your interest in the Town of Milton.
COMMERCIAL DRIVER’S LICENSE (CDL) APPLICANTS
If the position you are applying for requires a CDL and you receive an offer of employment, the
offer will be contingent on passing a Drug and Alcohol Test before beginning employment.
Pursuant to Sec. 40.25 (j) of CFR 49 Part 40 - An employer covered by DOT drug and alcohol testing
rules must ask a prospective employee who will be performing safety-sensitive functions for said employer
whether or not he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test
administered by another employer to which the employee applied for, did not obtain, safety-sensitive
transportation work covered by the DOT drug and alcohol testing rules during the past two years. If the
employee admits that he or she had a positive test or a refusal to test, the employer must not use the
employee to perform safety-sensitive functions until and unless the employee documents successful
completion of the return-to-duty process (Refer to Sec. 40.25 (b) (5) and (e).
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