Fillable Commonwealth of Massachusetts Department of Personnel Administration Municipal (City of Gloucester)

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Commonwealth of Massachusetts Department of Personnel Administration Municipal (City of Gloucester)

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The Commonwealth of Massachusetts Department of Personnel Administration Municipal (City of Gloucester) form is 3 pages long and contains:

  • 1 signature
  • 39 check-boxes
  • 40 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Gloucester

BROWSE CITY OF GLOUCESTER (MA) FORMS

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Commonwealth of Massachusetts
Department of Personnel Administration
Municipal Labor Service Application
For Cities and Towns Except Boston
For Office Use Only
I wish to apply for the following positions in the City of Gloucester
DEPARTMENT OF PUBLIC WORKS
Please check all positions applying for
Building Maintenance Series
Building Maintenance Man (1 year experience)
Building Maintenance Craftsman (2 year experience)
Utilities Maintenance Series (Water and Sewer)
Utilities Maintenance Man (1 year experience)
Utilities Maintenance Craftsman (2 year experience)
Highway Series (Roadway services)
Highway Maintenance Man (1 year experience)
Highway Maintenance Craftsman (2 year experience)
Machine Operator Series (Drivers)
Heavy Motor Equipment Operator (CDL Required)
Special Motor Equipment Operator (Requires special license to operator backhoe and front end loader)
Motor Equipment Operator
Motor Equipment Repair Series
Motor Equipment Maintenance Man (1 year related experience, CDL License)
Motor Equipment Repairman (2 year related experience)
Parks Maintenance Man (1 year experience)
Park Maintenance Series
Parks Maintenance Man (1 year experience)
Parks Maintenance Craftsman (2 year experience)
Other
Assistant Cook
Baker
(1 year experience)
Cafeteria Helper
Cook (1 year experience)
Stores
Delivery Man (1 year experience)
Mason (2 year experience
Carpenter (2 year experience)
Traffic Sign Erector
School Department : Please check all
positions
applying for:
Skating Rink Maintenance Man
Last Name __________________________________ First Name ___________________________ Middle ____
Street Address ________________________________________________________________________________
City _____________________________________________ State _____________ Zip Code _____________
Phone __________________________ Email _______________________________________________________
Date of Birth __________________ I will accept Temporary work Part time work
Have you completed a course in building, mechanical maintenance or repair trade Yes No
School/Program _____________________________________ Title of Course ___________________________
Dates Attended From __________________ To ______________________ Completed Yes No
Have you ever served in the Armed forces Yes No (if yes, provide a copy of your discharge, Form DD214)
Are you the widowed un-remarried spouse or parent of a veteran who died from service connected disability incurred in
wartime service Yes No
RESPONSE TO THE FOLLOWING IS VOLUNTARY. FAILURE TO PROVIDE THE INFORMATION
REQEUSTED WILL NOT ADVERSELY AFFECT YOUR APPLICATION.
I am Male Female
I am White Black Hispanic Asian American Indian or Alaskan Native Cape Verdean
Note: Labor Service requisition is valid for five (5) years, subject to all provisions of Civil Service Law and Rules. If you wish
to renew your registration beyond that time, you must notify the local Labor Service Director in writing no earlier than six (6)
months before, or no later than six (6) months after the fifth anniversary of your requisition. Failure to provide such
notification will result in removal from the Labor registration list.
I declare that the information I have provided on this application is true, and I understand that falsification of any
information is subject to the penalty of perjury.
Signature _________________________________________ Date _______________________________
List all positions held over the past ten years:
Names and Address of Employer ________________________________________________________________
Type of Work ______________________________ Date Employed From ______________ To _____________
Names and Address of Employer ________________________________________________________________
Type of Work ______________________________ Date Employed From ______________ To _____________
Names and Address of Employer ________________________________________________________________
Type of Work ______________________________ Date Employed From ______________ To _____________
Names and Address of Employer ________________________________________________________________
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Type of Work ______________________________ Date Employed From ______________ To _____________
Names and Address of Employer ________________________________________________________________
Type of Work ______________________________ Date Employed From ______________ To _____________
Names and Address of Employer ________________________________________________________________
Type of Work ______________________________ Date Employed From ______________ To _____________
You must file a separate Labor Service application for each City or Town in which you wish to be considered. Application may
be made in person or by mail at the Labor Registration Office in each City or Town listed below:
INFORMATION ABOUT POSITION TITLES FOR WHICH YOU MIGHT REGISTER MAY BE OBTAINED AT THE
LOCAL REGISTRATION OFFICES:
ACUSHNET, AGAWAM, ARLINGTON, ATTLEBORO, BEVERLY, BILLERICA, BROCKTON, BROOKLINE,
BURLINGTON, CAMBRIDGE, CHELSEA, CHICOPPEE, DARTMOUTH, DEDHAM, EAST HAMPTON, EVERETT,
FAIRHAVEN, FALLRIVER, FALMOUTH, FITCHBURG, FRANKLIN, GARDNER, GLOUCESTER, HAVERHILL,
HOLYOKE, HULL, LEOMINSTER, LOWELL, LYNN, MALDEN, MARLBOROUGH, MEDFORD, MELROSE,
METHUEN, MILTON, NEW BEDFORD, NEWTON, NORTH ADAMS, NORTHHAMPTON NORTH ANDOVER, NORTH
READING, NORWOOD, PEABODY, PITTSFIELD, QUINCY, RANDOLPH, REVERE, SALEM, SAUGUS,
SHREWSBURY, SOMERVILLE, SOUTH HADLEY, SPRINGFIELD, STONEHAM, STOUGHTON, SWAMPSCOTT,
TAUNTON, TEWKSBURY, WALTHAM, WATERTOWN, WESTFIELD, WEST SPRINGFIELD, WINTHROP, WOBURN,
WORCESTER.
Note; It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued
employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
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Commonwealth of Massachusetts Department of Personnel Administration Municipal (City of Gloucester)

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Completed 21 April 2021

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