Fillable Form 1547 (Town of East Hampton)

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Form 1547 (Town of East Hampton)

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The Form 1547 (Town of East Hampton) form is 4 pages long and contains:

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  • 37 check-boxes
  • 149 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of East Hampton

BROWSE TOWN OF EAST HAMPTON (NY) FORMS

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TOWN OF EAST HAMPTON
159 Pantigo Road
East Hampton, New York 11937
EMPLOYMENT APPLICATION
We consider applicants for all positions without regard to age, race, color, creed, religion, sex, nation origin,
Veteran status, disability, marital status, or any other legally protected status pursuant to federal, state, and local
laws. Please contact our Human Resources office if you are need of accommodation to complete this form.
(Please print or complete the form as a fillable PDF document)
Position: Date of Application
Last Name First Name
Middle Initial
A
ddress:
Street City State Zip Code
Phone Numbers:
Home Work Cell
1. A
re you under 18 years of age? Yes No
(If you answered yes to question 1, you must provide proof of eligibility to work.)
2. A
re you currently employed? Yes No
3. H
ave you previously been employed with the Town of East Hampton? Yes No
4. H
ave you ever filed an application with us in the past? Yes No
5. A
re you related to anyone currently working for the Town of East Hampton? Yes No
6. A
re you prevented from lawfully being employed in this country
because of Visa or Immigration status? Yes No
(proof of citizenship or immigration status will be required for employment)
7. Are you currently on “lay off” status or subject to recall? Yes No
8. C
an you travel if employment with us requires you to do so? Yes No
9. On what date would you be available for work? Date:
10. A
vailable to work: Full Time Part Time Temporary Weekends
11. Do you have a valid Driver’s License? State Issued Number Class
12. H
ave you been convicted of a felony or misdemeanor within the last 7 years? Yes No
(If you answered Yes to Question 12, please explain)
(conviction will not necessarily disqualify an applicant from employment)
EDUCATION
School Name/Location
Elementary School
High School
Undergraduate
College/University
Graduate/Professional
Years Completed
4 5 6 7 8
9 10 11 12
1 2 3 4
1 2 3 4
Diploma/Degree
Course Study
Describe any
specialized training
apprenticeship, skills
and extra-curricular
activities
Describe any honors
you may have received
13. Indicate any foreign languages you speak, read and or write
L
anguage Speak Read Write Fluent Good Fair
Language Speak Read Write Fluent Good Fair
L
anguage Speak Read Write Fluent Good Fair
Language Speak Read Write Fluent Good Fair
14. D
o you have any job related training from any branch of the United States military Yes No
(if you answered Yes to question 13 please describe the training received)
15. L
ist any professional, trade, business, or civic activities and offices held.
REFERENCES
P
rovide name, address and telephone number of three (3) references who are not related and are not
previous employers.
N
ame Address Telephone Number
N
ame Address Telephone Number
N
ame Address Telephone Number
EMPLOYMENT EXPERIENCE
Begin with your present or last job. Include any job related military service assignments and volunteer activities. You may
exclude organizations which indicate race, color, religion, gender, national origin, disability or other protected status.
Employer Address Telephone Number
Fr
om To Job Title Supervisor
S
tarting Hourly Salary Final Hourly Salary
R
eason for Leaving
Work Performed
Employer Address Telephone Number
Fr
om To Job Title Supervisor
S
tarting Hourly Salary Final Hourly Salary
R
eason for Leaving
Work Performed
Employer Address Telephone Number
Fr
om To Job Title Supervisor
Starting Hourly Salary Final Hourly Salary
R
eason for Leaving
Work Performed
Employer Address Telephone Number
Fr
om To Job Title Supervisor
S
tarting Hourly Salary Final Hourly Salary
R
eason for Leaving
W
ork Performed
Employer Address Telephone Number
Fr
om To Job Title Supervisor
S
tarting Hourly Salary Final Hourly Salary
R
eason for Leaving
Work Performed
(If you require additional space, please continue on a separate sheet of paper and attach it to this application)
APPLICANT’S STATEMENT
I
certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all
statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 1 year. Any applicant
wishing to be considered for employment beyond this time period should inquire as to whether or not applications are
being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with
this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may
discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship
may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing
by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information or any other deception given in my
application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and
regulations of the employer.
_________
____________________________________
Applicant’s Signature Date
FOR HUMAN RESOURCES USE ONLY BELOW THIS LINE
Interview Arranged? Yes No Date of Interview
R
emarks:
Interviewer(s)
E
mployed? Yes No Date Employed Hourly Rate / Salary
J
ob Title Department
By Date
A
dditional Notes:
The Town of East Hampton is an Equal Opportunity Employer
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Form 1547 (Town of East Hampton)

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Completed 15 July 2020

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