APPLICATION FOR EMPLOYMENT
02/25/19
Town of Mills
307-234-6679
704 4
th
Street
Mills, WY. 82644
APPLICANT INFORMATION
Last Name
First
M.I.
Street Address
Apartment/Unit #
City
State
ZIP
Phone
Cell Phone
Date of Birth
Driver License #
C.D.L.
YES
NO
Position Applied for
Date Available
Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the U.S.?
YES
NO
Have you ever worked for this company?
YES
NO
If so, when?
Have you ever been convicted of a felony?
YES
NO
If yes, explain
EDUCATION
High School
Address
From
To
Did you graduate?
YES
NO
Degree
College
Address
From
To
Did you graduate?
YES
NO
Degree
Other
Address
From
To
Did you graduate?
YES
NO
Degree
REFERENCES
Please list three PROFESSIONAL references.
Full Name
Relationship
Company
Phone
( )
Address
Full Name
Relationship
Company
Phone
( )
Address
Full Name
Relationship
Company
Phone
( )
Address
02/25/19
PREVIOUS EMPLOYMENT
Company Phone ( )
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone ( )
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone ( )
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
DESCRIBE ANY SPECIALIZED JOB OR MILITARY TRAINING, APPRENTICESHIP, SKILLS, OR ACTIVITIES
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Signature Date
PLEASE EMAIL THIS FORM TO
hr@millswy.gov
click to sign
signature
click to edit