TownofBerryville
ApplicationforEmployment
Wearean
equalopportunityemployeranddonotunlawfullydiscriminateinemployment.Noquestion
onthisapplicationisusedforthepurposeoflimitingorexcludinganyapplicantfromconsiderationfor
employmentonabasisprohibitedbylocal,state,orfederallaw.Equalaccesstoemployment,services,
andprogramsisavailabletoallpersons.Thoseapplicantsrequiringreasonableaccommodationtothe
applicationand/orinterviewprocessshouldnotifyarepresentativeoftheorganization.
Applicantname: Date:
P
osition(s)appliedforortypeofworkdesired:
A
ddress:
Phone#:
Dateyouwillbeavailabletostartwork:
Typeofemploymentdesired: full‐time part‐time temporary
Areyouabletomeettheattendancerequirements? YesNo
Doyouhaveanyobjectiontoworkingovertimeifnecessary? Yes No
Canyoutravelifrequiredbythisposition? YesNo
Haveyoueverbeenpreviouslyemployedbyourorganization? Yes No
Canyousubmitproofoflegalemploymentauthorizationandidentity? Yes No
Ifyouareunder18,canyoufurnishaworkpermitifitisrequired? Yes No
Haveyoueverbeenconvictedofacrimeinthelast7years? YesNo
Ifyes,pleaseexplain(aconvictionwillnotautomaticallybaremployment):
Driverslicensenumber State
Howwereyoureferredtous?
EmploymentHistory
Pleaseprovidealle
mploymentinformationforyourpastfouremployersstartingwiththemostrecent.
Employer: Positionheld:
Address: Telephone#:
Immediatesupervisorandtitle:
Datesemployed:fromtoSalary:
Jobsummary/Explanationofduties:
Reasonforleaving:
Application for Employment 08/2018
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Employer: Positionheld:
Address: Telephone#:
Immediatesupervisorandtitle:
Datesemployed:fromtoSalary:
Jobsummary/Explanationofduties:
Reasonforleaving:
Employer: Positionheld:
Address: Telephone#:
Immediatesupervisorandtitle:
Datesemployed:fromtoSalary:
Jobsummary/Explanationofduties:
Reasonforleaving:
Employer: Positionheld:
Address: Telephone#:
Immediatesupervisorandtitle:
Datesemployed:fromtoSalary:
Jobsummary/Explanationofduties:
Reasonforleaving:
OtherSkillsandQualifications
Summari
zea
nyjob‐relatedtraining,skills,licenses,certificates,and/orotherqualifications:
EducationalHistory
Listschoolnameandlocation,yearscompleted,cou
rseofstudy,andanydegr
eesearned:
Highschool:
College:
TechnicalTraining:
Other:
Application for Employment 08/2018
2 of 3
References
List3refere
n
ces’names,telephonenumbers,andyearsknown(donotincluderelativesoremployers):
Iherebyauthorizethepotentialemployertocontact,obtain,andverifytheaccuracyofinformation
containedinthisapplicationfromallpreviousemployers,educationalinstitutions,andreferences.Ialso
herebyreleasefromliabilitythepotentialemployeranditsrepresentativesforseeking,gathering,and
usingsuchinformationtomakeemploymentdecisionsandallotherpersonsororganizationsfor
providingsuchinformation.
Iunderstandthatanymisrepresenta
t
ionormaterialomissionmadebymeonthisapplicationwillbe
sufficientcauseforcancellationofthisapplicationorimmediateterminationofemploymentifIam
employed,wheneveritmaybediscovered.
IfIamemployed,Iacknowledgethatthereisnospecifiedlengtho
femploymentandthatthis
applicationdoesnotconstituteanagreementorcontractforemployment.Accordingly,eitherIorthe
employercanterminatetherelationshipatwill,withorwithoutcause,atanytime,solongasthereis
noviolationofapplicablefederalorstatelaw.
Iunderstandthatitisthepolicyofthisorganizationnottore
fusetohireorotherwisediscriminate
againstaqualifiedindividualwithadisabilitybecauseofthatperson’sneedforareasonable
accommodationasrequiredbytheADA.
IalsounderstandthatifIamemployed,Iwillberequi
redtoprovidesatisfactoryproofofidentityand
legalworkauthorizationwithinthreedaysofbeinghired.Failuretosubmitsuchproofwithinthe
requiredtimeshallresultinimmediateterminationofemployment.
IrepresentandwarrantthatIhavereadandfullyunderstandthe
foregoing,andthatIseekemployment
undertheseconditions.
Applicantsignature: Date:
Application for Employment 08/2018
3 of 3
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