Fillable APPLICATION FOR EMPLOYMENT - TOWN OF WALKERSVILLE, MD. (Burgess & Commissioners of Walkersville, MD)

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APPLICATION FOR EMPLOYMENT - TOWN OF WALKERSVILLE, MD. (Burgess & Commissioners of Walkersville, MD)

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BROWSE BURGESS & COMMISSIONERS OF WALKERSVILLE, MD (MD) FORMS

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APPLICATION FOR EMPLOYMENT - TOWN OF WALKERSVILLE, MD.

Instructions: Read the Announcement relating to this position and be sure you have the requirements stated. Type or print

your answers in ink. Answer every question clearly and completely. All statements are subject to investigation and verification.

Where a question does not apply, answer "NONE". Attach blank continuation sheets where necessary and sign each sheet. Do

not send original manuscripts; attach copies only.

RETURN TO: TOWN OFFICE, 21 WEST FREDERICK STREET, P O BOX 249, WALKERSVILLE, MD 21793

Name Position Applied For Lowest Acceptable Salary

________________________________________________________________________________________________________________________

Last Name First Middle

Street Address Home Phone (____)_______________When are you available__________________________

Work Phone(____)________________ Date

_______________________________________

City & State & Zip Code Do You Have a Valid Driver's License______Yes _______No

____________________________________________________________

Circle Highest School Year Completed: Give Name & Location of Grammar School or Did you Date Last

Grammar 1 2 3 4 5 6 7 8 High School Last attended: Graduate Attended or

High School 9 10 11 12 Graduated:____

G.E.D. ____Yes ____No ______Year ____________________________________ ____Yes ____No ____________

Month & Year

Name & Location of Undergraduate Major Subjects Studied - Specify Dates Attended Total Total Degree Field

College or University Semester/Quarter Hrs Credit From: To: Sem. Hrs. Qtr Hrs Rec'd

____________________________ ________________________ ____________ _______ _______ _____ ___________

____________________________ ________________________ ____________ _______ ________ _____ ___________

Name & Location of Graduate Major Subjects Studied - Specify Dates Attended Total Total Degree Field

University Semester/Quarter Hrs Credit From: To: Sem. Hrs. Qtr Hrs Rec'd

____________________________ _________________________ ____________ _______ ______ _____ __________

____________________________ ___________________ _________ _____ _____ ____ ________

Complete this item if you have taken courses at business, trade, armed services or correspondence school.

Name and Location of School Subject Total Hrs Total Weeks Date Finished

_______________________ ____________________________ ________ __________ _____________

________________________ ____________________________ ________ __________ _____________

May We Ask Your Present Have You Ever Been Convicted of a Crime ______Yes _________No

Employer About You?_____Yes _____No

Remarks: Use this space to give any special qualifications not covered elsewhere in your application (such as honors, driver's

license for a vehicle other than passenger car, other licenses, memberships in professional organizations, technical skills, or

special training) or other information requested as part of this application. Please include shorthand and typing speeds ( words

per minute).

__________________________________________________________________________________________________

___________________________________________________________________________________________

"Under Maryland law an employer may not require or demand any applicant for employment or prospective employment or

any employee to submit to or take a polygraph, lie detector or similar test or examination as a condition of employment or

continued employment. Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to

exceed $100." I hereby acknowledge that I have read the foregoing statement.

Date_______________ Signature_____________________________________________________

=========================================================================

FOR TOWN USE - DO NOT WRITE BELOW THIS LINE

Date Received________________ Exam Raw Conv Wgt Grade Notification

Referred _______________________ Performance______________________________________________________________________________

Rejected______________________Written ________________________________________________________________________________

Oral ___________________________________________________________________________________

Total Score_______________ T&E ___________________________________________________________________________________

Experience: In section A below, list the required information concerning your present position and then work back, using a

separate section for each previous position. If you are now unemployed, enter the word "Unemployed" after "Position" in

section A. If you have had military service, enter it below in its proper sequence. All periods of time unaccounted for in the

sections below or on blank continuation sheets will be considered periods of unemployment. Be sure to include all related

experience. If you were employed under another name, please indicate in remarks section on page one.

Starting Last

A. Position Dates of employment (month, year) #of mo. Salary Salary

List From : To:

Details ____________________ ____________________________ _____________ _______________ ________________

Employer Address #of hours worked per week

____________________ _____________________________________________ ________________________________

Name, title and phone number of immediate supervisor: #of Employees Supervised Reason for Leaving

____________________________________________ ___________________________ _______________________________

Describe duties, responsibilities and accomplishments:

________________________________________________________________________________________________________________________

Starting Last

B. Position Dates of employment (month, year) # of month Salary Salary

List

Details

___________________ ___________________________ ____________ ___________ _______

Employer Address # of hours worked per week:

_________________ ________________________ __________________________

Name, title and phone number of immediate supervisor: #of Employees Supervised Reason for leaving:

____________________________________________ ______________________ ____________________________

Describe duties, responsibilities and accomplishments:

____________________________________________________________________________________________________________

___________________________________________________________________________________________________________

____________________________________________________________________________________________________________

I hereby certify that every statement I have made in this application is true and complete to the best of my knowledge and

belief, and I understand that any false or incomplete statement I have made may result in my forfeiting all rights of

employment with the TOWN OF WALKERSVILLE.

I hereby authorize the Town of Walkersville to obtain from my past employers, educational institutions, and/or any law

enforcement agencies all data needed to support this application. ________Yes __________No

Date__________________________________ Signature ______________________________________________________

(NOTE: UNSIGNED APPLICATIONS MAY BE REJECTED WITHOUT FURTHER NOTICE)

WORK EXPERIENCE SUMMARY - CONTINUATION FORM TO APPLICATION FOR EMPLOYMENT

____________________________________________________________________________________________________________

You are to use this continuation form to provide additional information concerning previous positions you have held. It is

important for you to furnish all information requested below in sufficient detail to enable the Personnel Department to give

you full credit in evaluating your qualifications.

Experience: Below list the required information concerning each previous position. If you have had military service, enter it

below in its proper sequence. All periods of time unaccounted for in the blocks below will be considered periods of

unemployment. Be sure to include all related experience. If you were employed under another name, please indicate.

Starting Last

Position Dates of employment (month, year) # of mo. Salary Salary

From: To:

____________________ ______________________________ ________ __________ ___________

Employer Address # of hours worked per week:

__________________ __________________________ ____________________________________

Name, title and phone number of immediate supervisor: #of Employees Supervised Reason for Leaving

______________________________________________ _______________________ ___________________

Describe duties, responsibilities and accomplishments:

__________________________________________________________________________________________________

Starting Last

Position Dates of employment (month, year) # of mo. Salary Salary

From: To:

____________________ ______________________________ ________ __________ ____________

Employer Address # of hours worked per week:

__________________ ___________________________ _____________________________________

Name, title and phone number of immediate supervisor: #of Employees Supervised Reason for Leaving

______________________________________________ _______________________ ___________________

Describe duties, responsibilities and accomplishments:

__________________________________________________________________________________________________

I hereby certify that every statement I have made in this application is true and complete to the best of my knowledge and

belief, and I understand that any false or incomplete statement I have made may result in my forfeiting all rights of

employment with the TOWN OF WALKERSVILLE

I hereby authorize the Town of Walkersville to obtain from my past employers, educational institutions, and/or any law

enforcement agencies all data needed to support this application. _________Yes __________No

Date__________________________________ Signature ______________________________________________________

(NOTE: UNSIGNED APPLICATIONS MAY BE REJECTED WITHOUT FURTHER NOTICE)

Starting Last

Position Dates of employment (month, year) # of mo. Salary Salary

From: To:

____________________ ______________________________ ________ __________ ___________

Employer Address # of hours worked per week:

__________________ __________________________ ____________________________________

Name, title and phone number of immediate supervisor: #of Employees Supervised Reason for Leaving

______________________________________________ _______________________ ___________________

Describe duties, responsibilities and accomplishments:

__________________________________________________________________________________________________

Starting Last

Position Dates of employment (month, year) # of mo. Salary Salary

From: To:

____________________ ______________________________ ________ __________ ____________

Employer Address # of hours worked per week:

__________________ ___________________________ _____________________________________

Name, title and phone number of immediate supervisor: #of Employees Supervised Reason for Leaving

______________________________________________ _______________________ ___________________

Describe duties, responsibilities and accomplishments:

__________________________________________________________________________________________________

I hereby certify that every statement I have made in this application is true and complete to the best of my knowledge and

belief, and I understand that any false or incomplete statement I have made may result in my forfeiting all rights of

employment with the TOWN OF WALKERSVILLE

I hereby authorize the Town of Walkersville to obtain from my past employers, educational institutions, and/or any law

enforcement agencies all data needed to support this application. ________Yes __________No

Date__________________________________ Signature ______________________________________________________

(NOTE: UNSIGNED APPLICATIONS MAY BE REJECTED WITHOUT FURTHER NOTICE)

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APPLICATION FOR EMPLOYMENT - TOWN OF WALKERSVILLE, MD. (Burgess & Commissioners of Walkersville, MD)

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Completed 24 January 2021

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