Fillable EMPLOYMENT APPLICATION (Inc. Village of Freeport)

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EMPLOYMENT APPLICATION (Inc. Village of Freeport)

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U.S.A. forms for Inc. Village of Freeport

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IF HIRED YOU WILL HAVE TO PROVIDE DOCUMENTS VERIFYING YOUR ELIGIBILITY TO WORK IN THE U.S.
EMPLOYMENT APPLICATION
INCORPORATED VILLAGE OF FREEPORT
Human Resources Department
46 No. Ocean Avenue
Freeport, NY 11520
www.freeportny.gov
PLEASE PRINT – All questions must be answered – Incomplete applications will NOT be accepted
Name:__________________________________________________________ Date:______________________
Address:________________________________________________________ Town:_____________________
Note: Must be a current Freeport resident to be eligible for employment – proof of residency must be submitted
How long at this address
:___________ Phone#:________________________ Soc. Sec. #:_______________
Last previous address:______________________________ Town:_________________ How long:_________
Are you over 18 years of age?________________________ Are you a US Citizen?_____________________
Who referred you to us?____________________________________________________________________
Military Service:__________________________Dates:____________________to______________________
Branch: _________________________ Type of Discharge: ________________________________________
Exempt Fireman?__________________________ If yes, attach certificate____________________________
Driver’s License?_________ Driver’s Identification #______________________ License Class#____________
Position applied for:____________________________ _____________________________Min. Sal._______
(1
st
Choice) (2
nd
Choice)
How soon available, accepted?_______________________________________________________________
State months, days and hours preferred: _______________________________________________________
RECORD OF EMPLOYMENT (PUT PRESENT OR LAST EMPLOYER FIRST)
DATES
FROM
TO
NAME AND ADDRESS OF
EMPLOYER
POSITION
REASON FOR
LEAVING
.
rev. (9/19) 1 of 3
OFFICE USE ONLY
Applicant_______________________________________
Application given by______________________________
Interviewed by___________________________________
Rating__________________________________________
Remarks:
RECORD OF
EDUCATION
GRADUATE?
(YES/NO)
TYPE OF
DEGREE
EARNED
MIDDLE SCHOOL
HIGH SCHOOL
COLLEGE
OTHER
REFERENCES – (DO NOT LIST FORMER EMPLOYERS OR RELATIVES)
NAME
ADDRESS & TELEPHONE
POSITION & RELATIONSHIP
If “YES” to any of the questions below, please explain in the space provided:
rev. (9/19) 2 of 3
Do you object to the Village of Freeport making an inquiry about your character and qualifications
from your present employer? Yes No
Have you ever had a drivers license suspended or revoked? Yes No
Have you received any summons for traffic violations within the past three years? Yes No
Except for traffic offenses, have you ever been convicted of any violation, misdemeanor, or
felony? Yes No
Are there any criminal charges pending against you at this time? Yes No
Were you ever dismissed from employment for reasons other than reduction in staff? Yes No
IF YES to any of the above questions, please explain: ________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
____________________________________________________________________________________
Do you possess any status under Nassau County Civil Service? ____________________________________
Have you worked for the Village of Freeport before?__________ If yes, when?_________________________
What machines do you operate (including office)?________________________________________________
________________________________________________________________________________________
Have you ever been bonded?_____________ Has a bond ever been refused to you?____________________
List any relatives employed by the Village of Freeport:_____________________________________________
IF HIRED, I UNDERSTAND THAT MY APPOINTMENT WILL BE PROBATIONARY AND WILL ALSO BE
SUBJECT TO APPROVAL BY THE NASSAU COUNTY CIVIL SERVICE COMMISSION. I CERTIFY THAT
ALL OF THE INFORMATION I HAVE GIVEN IS TRUE AND CORRECT, TO THE BEST OF MY
KNOWLEDGE.
____________________________________________________________________________
SIGNATURE OF APPLICANT
DO NOT WRITE BELOW LINE – OFFICE USE ONLY
DEPARTMENT HEAD’S RECOMMENDATION_______________________________________________________
REQUESTED START DATE:__________________________________________________________________
May be subject to Civil Service approval
Job Title__________________________ Grade & Year______________________________ Salary_________________
MAYOR’S APPROVAL___________________________________________________________________________
The Inc. Village of Freeport provides equal employment opportunities (EEO) to all employees and applicants for employment
without regard to race, color, religion, sex, national origin, age, disability, or genetics
rev. (9/19) 3 of 3
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EMPLOYMENT APPLICATION (Inc. Village of Freeport)

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Completed 18 January 2021

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