POSITION APPLIED FOR:
APPLICANT TELEPHONE:
SOCIAL SECURITY NUMBER:
YOUR NAME:
Last
First
Middle
ADDRESS:
(If yes, verification will be required.)
Yrs. Completed
High School
College/University
Business/Technical
Other
MILITARY SERVICE:
Duty/Specialized Training:
EMPLOYMENT:
LIST LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST.
Employer Name and Address Position Title/Duties Skills
Dates Employed
from
to
Reason for leaving
Supervisor's Name:
Telephone:
Employment Application
Graduate or Degree
ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE U.S.A.?
I AM SEEKING A PERMANENT POSITION:
Field of Study
www.newbostonnh.gov
APPLICANT EMAIL:
EDUCATION:
Yes
No
Civic, Athletic, Etc.
ACTIVITIES:
Professional Licenses, Certifications or Registrations:
regarding this position that you wish to bring to the employer's attention:
Summarize other additional employment, skills , or informtion
GENERAL:
An Equal Opportunity Employer
Town of New Boston
7 Meetinghouse Hill Road
PO Box 250
New Boston, NH 03070
(603) 487-2500
Yes No
DATE THAT YOU CAN START WORK:
If No, Explain Briefly,
Yes
No
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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