Fillable Commissioners Office, 2 Turner Street, Auburn, ME 04210 (County of Androscoggin)

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Commissioners Office, 2 Turner Street, Auburn, ME 04210 (County of Androscoggin)

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The Commissioners Office, 2 Turner Street, Auburn, ME 04210 (County of Androscoggin) form is 4 pages long and contains:

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  • 20 check-boxes
  • 48 other fields

Country of origin: US
File type: PDF

U.S.A. forms for County of Androscoggin

BROWSE COUNTY OF ANDROSCOGGIN (ME) FORMS

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Page 1 of 4
Androscoggin County provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination.
Please print clearly in ink or type. Answer every question completely. Applications may be mailed or delivered to the
address above or emailed to sberube@androscoggincountymaine.gov
. Date: _____________________
Position applied for:
Name:
Last First Middle Initial
Mai
ling Address:
Street Town/City State Zip Code
P
hysical Address:
Street Town/City State Zip Code
P
hone:
Primary Phone Alternate Phone
E
mail address:
I
n case of emergency, notify:
Name/Relationship Phone
A
re you over 18 years of age? Yes No
L
ist any other names you have used:
D
o you have any relatives who are currently employed by Androscoggin County? Yes No
H
ave you ever been employed with us before? Yes No If yes, what department?
A
re you a U.S. citizen? Yes No
W
hen would you be available for employment?
Are you able to perform the job functions of the position you are applying for? (Please read the job description fully
before answering) Yes No
I
f no, list only the accommodation(s) needed.
Commissioners’ Office, 2 Turner Street, Auburn, ME 04210 (207) 753-2526
Page 2 of 4
Do you possess a valid driver’s license? Yes
No
Driv
er’s License #:
Number Expiration Date
If yo
ur answer is yes to either of the next two questions, please explain fully.
1. Have y
ou ever been convicted of a felony? Yes No
2. Would you object to a physical examination? Yes No
Educat
ion
Did you graduate from high school? Yes No
Did you graduate from College? Yes No
Colleg
e/University:
Name Location Years Completed Major Area of Study
College/University:
Name Location Years Completed Major Area of Study
Colleg
e/University:
Name Location Years Completed Major Area of Study
Gradua
te School:
Name Location Years Completed Major Area of Study
Othe
r (Specify)
Experience: Start with most recent employer. Please explain any gaps in work history. Do not use “See Resume”
Employer #1:
Name Street City State Zip code
Job T
itle:
Description of Duties:
Employm
ent Dates:
Starting Date Ending Date
Reas
on for leaving:
Page 3 of 4
Supervisor:
Name Title Phone
Emp
loyer #2:
Name Street City State Zip code
Job
Title:
Des
cription of Duties:
Empl
oyment Dates:
Starting Date Ending Date
Rea
son for leaving:
Sup
ervisor:
Name Title Phone
Emp
loyer #3:
Name Street City State Zip code
Job
Title:
Des
cription of Duties:
Empl
oyment Dates:
Starting Date Ending Date
Rea
son for leaving:
Sup
ervisor:
Name Title Phone
Emp
loyer #4:
Name Street City State Zip code
Job
Title:
Page 4 of 4
Description of Duties:
Empl
oyment Dates:
Starting Date Ending Date
Rea
son for leaving:
Sup
ervisor:
Name Title Phone
Personal References (Not Former Employers or Relatives)
Reference:
Name Occupation Phone
Refer
ence:
Name Occupation Phone
Refer
ence:
Name Occupation Phone
Job Application, Agreement and Certification
I certify that the information given by me in this application and accompanying resume (if any) is true in all respects to the best of my
knowledge. I realize that any false statements or omissions of material facts shall be considered sufficient cause for immediate
dismissal without notice if/when discovered.
I authorize the use of any information in this application to verify my statements, and I authorize my past employers, all references,
and any other person to answer all questions concerning my ability, character, reputation and previous employment records. I release
all such persons from any liability or damages as a result of having furnished such information.
I agree and understand that the County of Androscoggin or it’s agent may obtain any transcripts, records and documents necessary to
investigate my background to ascertain any and all information concerning my record, whether same is of record or not, and I release
Androscoggin County and its agents from all liability for any damages as a result of obtaining or furnishing of such information.
I agree that this application for employment in no way obligates the County of Androscoggin to hire me.
I agree that if hired, I will be required to serve a probationary period as specified in the County of Androscoggin’s Personnel Policy.
In making this application, I also understand that an investigative report may be made as to my character, reputation, ability and credit
record.
I understand and agree that if submitting this Application for Employment electronically, I agree my electronic signature is the legal
equivalent of my manual signature on this Agreement, and I consent to all of the above stated certifications, authorizations and
agreements.
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Commissioners Office, 2 Turner Street, Auburn, ME 04210 (County of Androscoggin)

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Completed 17 July 2020

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