EMPLOYMENT CONTINUED
Employer Name and Address
Position Title/Duties Skills
Dates Employed
from
to
Reason for leaving
Supervisor's Name:
Telephone:
Employer Name and Address Position Title/Duties Skills
Dates Employed
from
to
Reason for leaving
Supervisor's Name:
Telephone:
In case of accident or illness please contact: Name:
Address:
"I CERITIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF
ANY FALSE INFORMATION, OBMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM
EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME.
IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE TOWN OF NEW BOSTON, AND I
AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT
ANY TIME BY THE TOWN. I UNDERSTAND THAT NO DEPARTMENT HEAD HAS THE AUTHORITY TO ENTER INTO ANY AGREEMENT FOR
EMPLOYMENT CONTARY TO THE FOREGOING."
I understand and agree to the information shown
above:
Signature: Date:
Employer Section:
Daytime phone:
Relationship:
Years known
Occupation
Telephone
Address
Name
REFERENCES: List three personal references who are not relatives or former supervisors.
Years known
Occupation
Telephone
Address
Name
Years known
OccupationTelephone
Address
Name
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