Fillable Job Application Job Application (City of Holderness)

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Job Application Job Application (City of Holderness)

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BROWSE CITY OF HOLDERNESS (NH) FORMS

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The Town of Holderness is an Equal Opportunity Employer Revised: 2/3/2020
Town of Holderness, New Hampshire
1089 US Route 3
Holderness, NH 03245
Application for Employment
Employees of the Town and applicants for employment shall be afforded equal opportunity in all aspects
of employment without regard to race, color, religion, sex, national origin, age, marital status, sexual
orientation, disability or any other basis protected by law.
(Please Print or Type)
Type of School
Name of School
Location
(City and State)
# of years
Completed
Major &
Degree
High School
Trade School
College
Graduate
Professional
PERSONAL
Date:
Name:
Position applied for:
Department:
Availability: __ Full-time __ Part-time __ Seasonal
Email:
Street Address:
Cell Phone:
City:
State:
Zip:
Home Phone:
Days/hours available to work: _____ No Pref _____ Mon _____ Tues _____ Wed _____ Thurs
_____ Fri _____ Sat _____ Sun
How many hours can you work weekly? _____________________ Can you work nights?
If under 18 years of age, can you provide required proof of your eligibility to work? Yes No
Are you legally authorized to work in the United States? Yes No
EDUCATION
The Town of Holderness is an Equal Opportunity Employer Revised: 2/3/2020
*List most recent employer first.
Company:
Your Title:
Address:
Employed from:
City, State, Zip:
Employed to:
May we contact your present employer?
Responsibilities:
Supervisor’s name:
Phone No:
Reason for leaving:
Company:
Your Title:
Address:
Employed from:
City, State, Zip:
Employed to:
May we contact this employer?
Responsibilities:
Supervisor’s name:
Phone No:
Reason for leaving:
Company:
Your Title:
Address:
Employed from:
City, State, Zip:
Employed to:
May we contact this employer?
Responsibilities:
Supervisor’s name:
Phone No:
Reason for leaving:
Company:
Your Title:
Address:
Employed from:
City, State, Zip:
Employed to:
May we contact this employer?
Responsibilities:
Supervisor’s name:
Phone No:
Reason for leaving:
Did you complete this application yourself Yes No
If not, who did? _______________________________________________________________________
EMPLOYMENT HISTORY
The Town of Holderness is an Equal Opportunity Employer Revised: 2/3/2020
Have you ever served in the US Armed Forces? Yes No
If yes, what branch? _______________________________
Describe any training received which would be relevant to the position for which you are applying:
____________________________________________________________________________________
Please list two references other than relatives or previous employers.
Name: ___________________________________ Name: _________________________________
Position: _________________________________ Position: _______________________________
Company: ________________________________ Company: ______________________________
Address: _________________________________ Address: _______________________________
__________________________________ _______________________________
Telephone: _______________________________ Telephone: _____________________________
Do you have a driver’s license? Yes No
What is your means of transportation to work? _______________________________________________
Driver’s License number: __________________________________ State of issue: _________________
Operator Commercial (CDL) Chauffeur Expiration date: ________________
Have you had any accidents during the past three years? __________________ How many? __________
Have you had any moving violations during the past three years? ___________ How many? __________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
MILITARY
REFERENCES
DRIVING HISTORY
SPECIFIC SKILLS
The Town of Holderness is an Equal Opportunity Employer Revised: 2/3/2020
PLEASE READ CARFULLY BEFORE SIGNING
In exchange for the consideration of my job application by the Town of Holderness (hereinafter called
“the Town”), I agree that:
Neither the acceptance of this application nor the subsequent entry into any type of employment
relationship, either in the position applied for or any other position, and regardless of the contents of
employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist
from time to time, or other Town practices, shall serve to create an actual or implied contract of
employment, or to confer any right to remain an employee of the Town, or otherwise to change in any
respect the employment-at-will relationship between it and the undersigned, and that relationship cannot
be altered except by a written instrument signed by the Chairman of the Board of Selectmen or Town
Administrator. Both the undersigned and the Town may end the employment relationship at any time,
without specified notice or reason. If employed, I understand that the Town may unilaterally change or
revise their benefits, policies and procedures and such changes may include reduction in benefits.
I authorize investigation of all statements contained in this application. I understand that the
misrepresentation or omission of facts called for is cause for dismissal at any time without any previous
notice. I herby give the Town permission to contact schools, previous employers (unless otherwise
indicated), references, and others, and herby release the Town from any liability as a result of such
contract.
I also understand that (1) the town has a drug and alcohol policy that provides for pre-employment testing
as well as testing after employment; (2) consent to and compliance with such policy is a condition of my
employment; and (3) continued employment is based on the successful passing of testing under such
policy. I further understand that continued employment may be based on the successful passing of job-
related physical examinations.
I understand that, in connection with the routine processing of your employment application, the Town
may request from a consumer reporting agency an investigative consumer report including information as
to my credit records, character, general reputation, personal characteristics, and mode of living. Upon
written request from me, the Town, will provide me additional information concerning the nature and
scope of any such report requested by it, as required by the Fair Credit Reporting Act.
I further understand that my employment with the Town shall be probationary for a period of ninety (90)
days, and further that at any time during the probationary period or thereafter, my employment relation
with the Town is terminable at will for any reason by either party.
Signature of Applicant: _________________________________________ Date: _________________
CERTIFICATION AND AGREEMENT
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Job Application Job Application (City of Holderness)

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Completed 14 July 2020

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