APPLICATION
FOR
EMPLOYMENT
FOR THE
TOWN OF WOODSTOCK
Town of Woodstock
135 North Main Street
Woodstock, Virginia 22664
Phone: 540.459.3621
Fax: 540.459.3085
www.townofwoodstockva.gov
AN EQUAL OPPORTUNITY EMPLOYER
ADA REASONABLE ACCOMMODATIONS UPON REQUEST
2
Instructions: Please complete the entire application. Incomplete applications WILL NOT be considered.
Mail or bring your completed application to the Town of Woodstock Municipal Office at 135 North Main
Street, Woodstock, Virginia 22664.
POSITION APPLYING FOR ________________________ DATE OF APPLICATION __________
PRINT NAME __________________________________________________________________
(LAST) (FIRST) (MIDDLE)
ADDRESS _____________________________________________________________________
CITY ______________________________ STATE _____________ ZIP _____________
PHONE Home (_____) ___________________ Work (_____) ___________________
EMAIL _________________________________________ Best Time to Contact You? __:____AM/PM
Are you legally eligible to work in the U.S.? Yes No Are you a veteran? Yes No
(Proof of citizenship or immigration status will be required upon employment)
Do you have a valid driver’s license? Yes No Commercial Drivers License? Yes No
Expiration date: ___________________ Driver’s License Number: _______________________
Have you previously filed an application with the Town of Woodstock? Yes No
If “YES” give position applied for and date ________________________________________________
Are you currently employed? Yes No May we contact your present employer? Yes No
Date available for work ____/____/____ What is you desired salary range? _______________________
EDUCATION: Name and location of high school attended: ___________________________________
___________________________________________________________________________________
Did you graduate? Yes No If not, have you passed a G.E.D. test? Yes No
School &
Location
From
To
Date Graduated
Degree
Major Area of Study
3
SPECIAL QUALIFICATIONS AND SKILLS (please describe any specialized training and skills, professional
licenses and certificates, publications, scholastic honors, foreign languages, etc.):
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
PROFESSIONAL, TRADE, BUSINESS, OR CIVIC ACTIVITIES AND OFFICES HELD (you may
exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other
protected status):
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
EMPLOYMENT EXPERIENCE: Start with your present job and work back, include military and volunteer
experience. Additional experience should be listed by attaching separate sheets of paper or a personal resume.
Be sure to include all requested information.
Present Employer ____________________________________________________________________
Address____________________________________________________________________________
Phone Number (____) _____________________ Fax (____) _____________________
Job Title ________________________ Starting Salary _________ Present/Ending Salary _________
Dates of Employment: From _____________ to _____________ Hours per week _________
Supervisor’s Name ___________________________________________________________________
Reason for Leaving ___________________________________________________________________
Work Description ____________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
4
Employer __________________________________________________________________________
Address____________________________________________________________________________
Phone Number (____) _____________________ Fax (____) _____________________
Job Title ________________________ Starting Salary _________ Present/Ending Salary _________
Dates of Employment: From _____________ to _____________ Hours per week _________
Supervisor’s Name ___________________________________________________________________
Reason for Leaving ___________________________________________________________________
Work Description ____________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Employer ____________________________________________________________________
Address____________________________________________________________________________
Phone Number (____) _____________________ Fax (____) _____________________
Job Title ________________________ Starting Salary _________ Present/Ending Salary _________
Dates of Employment: From _____________ to _____________ Hours per week _________
Supervisor’s Name ___________________________________________________________________
Reason for Leaving ___________________________________________________________________
Work Description ____________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
5
Have you ever been dismissed or forced to resign a position? Yes No
Have you ever been convicted of any offense against the law? Please omit juvenile offenses and minor traffic
violations. Include convictions by general court martial while in the military service. Yes No
If “YES”, give date, place, charge, court, and fine or sentence. __________________________________
___________________________________________________________________________________
_______________________________________________________________________
(A conviction does not automatically mean that you cannot be employed. What you were convicted of and how long ago are important.
Give all the facts so that a decision can be made.)
How did you learn about the position for which you are applying? _______________________________
__________________________________________________________________________________
ADDITIONAL INFORMATION: State any additional information that you feel may be helpful to us in
considering your application. Please also feel free to include your personal resume with this application.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
REFERENCES:
1. Name_______________________________________________________________________
Address_____________________________________________________________________
Phone Number (____) _____________________
2. Name_______________________________________________________________________
Address_____________________________________________________________________
Phone Number (____) _____________________
3. Name_______________________________________________________________________
Address_____________________________________________________________________
Phone Number (____) _____________________
6
Note to Applicants: Please do not answer this question unless you have been informed about the
requirements of the job for which you are applying:
Can you perform the essential functions of the job for which you are applying, either with or without a
reasonable accommodation? Yes No
Thank you for your interest in the Town of Woodstock!
ATTENTION: THIS STATEMENT MUST BE SIGNED.
I certify that the statements made by me in this application are true,
complete, and correct to the best of my knowledge, and that
misrepresentation or omissions may result in the rejection of my application,
permanent ineligibility for appointments, or dismissal.
_____________________________________________ _______________
Signature of Applicant Date
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