EDUCATION
List certifications, training, skills, and abilities applicable to this position:
If previously employed by the Town, or an applicant for a previous position, specify position(s) and
approximate date(s):
Indicate any relatives currently working for the Town
If
you are a veteran, list branch and dates of service
IF THIS POSITION WILL REQUIRE DRIVING A VEHICLE, complete the following:
Social Security No.
Driver’s
License Type State
Lic.
No. Exp. date
If
the answer is yes to any of the following questions, specify the date and circumstances below:
•
Have you ever been denied a license to operate a motor vehicle? Yes ___ No ___
• Has your license ever been suspended or revoked? Yes ___ No ___
•
Have you been convicted of a DUI or DWAI within the last 10 years? Yes ___ No ___
•
Have you had more than two moving violations within the last 5 years? Yes ___ No ___
• Have you ever had an accident while driving an employer’s vehicle? Yes ___ No ___
• Have you ever been convicted of leaving the scene of an accident? Yes ___ No ___
PERSONAL REFERENCES (do not include employers or relatives)
Proof of citizenship or eligibility to work will be required upon hire. Job offers for certain safety-related positions -- heavy
equipment operator, bus driver, commissioned law enforcement officer -- are conditional on drug testing.
I certify that all statements contained herein are true and complete. I authorize investigation of all statements made in this
employment application and the obtainment of all other information deemed necessary in this matter, and release all
persons and entities from any and all liability in responding to such inquiries. A photocopy of this release may be used
for these purposes. I understand that misrepresentation or omission may be cause for non employment or termination after hire.
Signature
Date
The Town of Telluride is an Equal Opportunity Employer
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signature
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