Fillable Part Time Employment Application (Town of Boxborough)

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Part Time Employment Application (Town of Boxborough)

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The Part Time Employment Application (Town of Boxborough) form is 4 pages long and contains:

  • 1 signature
  • 34 check-boxes
  • 72 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Boxborough

BROWSE TOWN OF BOXBOROUGH (MA) FORMS

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Part-Time (less than 20 hours), Seasonal and Temporary Employment Application
TOWN OF BOXBOROUGH
29 Middle Road
Boxborough, Massachusetts 01719
Employment Application
The Town of Boxborough is an Affirmative Action / Equal Employment Opportunity Employer
All information must by typed or printed legibly. Unreadable application will be discarded.
1. Date of Application: 2. Position Applying For:
3. Name:
Last First Middle
4. Address:
Number Street Apartment Number
City/Town State Zip Code
5. Telephone Numbers: Home: Daytime:
Area Code / Number Area Code / Number
Mobile:
Area Code / Number
6. Email Address:
7. Driver’s License Number:
Class / Number / State
8. If hired, can you provide proof of citizenship or legal right to work?
YES
NO
9. Are you under 18 years of age?
YES
NO If yes, date of birth?
10. Have you ever been employed by the Town before?
YES
NO
If yes, when? In which department?
11. Do you have an immediate family member (i.e. spouse, mother, father, sibling, or child) working for the Town of Boxborough?
YES
NO
If yes, Employee’s Name: Department:
Name / Location Course of Study
Years
Completed
Did you graduate? Degree
High School
YES
NO
College
YES
NO
Graduate School
YES
NO
Business/Technical
YES
NO
Personal Information
Education
12. Do you possess the following skills? Please list in detail all that apply.
Specialized Training?
YES
NO Name of Training/Course:
Professional Licenses?
YES
NO Licenses:
Professional Memberships?
YES
NO Name of Organizations:
Computer Software?
YES
NO Name of Programs:
Office Equipment?
YES
NO Describe Equipment:
If more room is required, an additional sheet may be attached.
List present employer first. A resume or supplemental sheet may be included; however, this section must be completed.
13. Employer’s Name:
Address: Telephone Number:
Job title: Worked From: To:
Immediate Supervisor’s Name and Job Title:
May we contact this employer?
YES
NO
Describe the work you performed:
Reason(s) for leaving:
14. Employer’s Name:
Address: Telephone Number:
Job title: Worked From: To:
Immediate Supervisor’s Name and Job Title:
May we contact this employer?
YES
NO
Describe the work you performed:
Reason(s) for leaving:
Please provide professional and/or business references only. Note that references listed in this section will be contacted.
15. Reference #1
Name: Address:
Business Position: Telephone Home:
Work:
16. Reference #2
Name: Address:
Business Position: Telephone Home:
Work:
17. How did you learn about the job for which you are applying?
Walk-in
Town Employee
Newspaper; title
Professional Journal; title
Posted Town Bulletin
the Internet
Employment History
References
I certify that the information provided in this application for employment is true and complete to the best of my knowledge. In the event
of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.
I authorize investigation of all statements contained in this application and the release of any pertinent information regarding my
education, past employment history and background. I authorize the Town of Boxborough to obtain any information from schools,
employers, professional licenses, certifications, driver’s license and history (if job related), professional references and any other
information concerning knowledge, skills and abilities. This information may include, but is not limited to: academics, achievement,
performance, attendance, personal history and discipline. Further, I hereby authorize all references, persons, schools, my current
employer (if applicable) and previous employers and organizations named in this application, unless otherwise stated, to provide the
Town of Boxborough any relevant information that may be required to arrive at an employment decision. I understand that the
information released is for the Town of Boxborough’s use only.
I hereby voluntarily release, discharge and exonerate the Town of Boxborough, its agents and representatives, and any person so
furnishing information from any and all liabilities of every nature and kind arising out of the furnishing or inspection of such documents,
records and other information or the investigations made by or on behalf of the Town of Boxborough.
I understand that all appointments are probationary and that I must demonstrate my ability for continued employment. I also
understand that I must be available from time to time to work outside normal business hours, as the needs of the department require.
I understand that any offer of employment that I receive from the Town of Boxborough may be contingent upon my successful
completion of the pre-employment screening process, including, but not limited to, the Town of Boxborough receiving satisfactory
references, review of my driving history, completion of a complete criminal background check and/or a Sex Offender Record
Information (“SORI”) check, and if appropriate, pre-employment drug test, physical examination, and/or psychological screening. I
understand that any such test results will be communicated in a confidential manner.
I understand that any employment offer by the Town is conditional upon my ability to establish employment eligibility under the
Immigration Reform and Control Act of 1986 and an I9 so certifying must be completed no later than the first day of employment.
I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.
Signature: Date:
Discrimination against any person in any practice or procedure in advertising, recruitment, referrals, testing, hiring, transfer, promotion
or any other term, condition or privilege of employment which limits or adversely affects employment opportunities because of political
or religious opinions or affiliations, or because of age, color, disability, criminal records (inquiries only), gender, genetics, military
service, national origin, ancestry, race, religion, past participation in discrimination complaints, sexual orientation, gender identity,
marital status, pregnancy, parenthood, or disability which is unrelated to the person’s occupational qualifications or any other non-merit
factor which is not a bona fide occupational qualification is prohibited.
It is unlawful in Massachusetts to require a lie detector test as a condition of employment or continued
employment. An employer who violates that law shall be subject to criminal penalties and civil liabilities.
Agreement
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signature
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Town of Boxborough
Release
I , a candidate for the position of , hereby
authorize the Town of Boxborough to investigate all statements in my application and to secure any necessary
information from all my employers, references, and academic institutions. I hereby release all of those
employers, references, academic institutions, and the Town of Boxborough from any and all liability arising
from their giving or receiving information about my employment history, my academic credentials or
qualifications, and my suitability for employment with the Town of Boxborough.
I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my
academic credentials and employment references. I further understand that any false or misleading
statements will be sufficient cause for rejection of my application if the Town of Boxborough has not yet
employed me and for immediate dismissal if the Town of Boxborough has employed me. I also authorize the
Town to supply information about my employment record, in whole or in part, in confidence to any prospective
employer, government agency, or other party having legal and proper interest, and I hereby release the Town
of Boxborough from any and all liability for its providing this information.
In the event of my employment with the Town of Boxborough, I shall comply with all rules, regulations, and
policies set forth in the Town of Boxborough’s Salary Administration Plan Bylaw or other communications
distributed by the Town of Boxborough.
I understand that nothing in this employment application, in the Town of Boxborough’s policy statements or
personnel guidelines, or in my communications with any Town of Boxborough official is intended to create an
employment contract between the Town of Boxborough and me. No promises regarding employment have
been made to me and I understand that no such promise or guarantee is binding upon the Town of
Boxborough unless it is made in writing and signed by a Town of Boxborough official who possesses the
authority to make such promise or guarantee.
I hereby acknowledge that I have read and understand the preceding statement.
Signed: Date:
[Signature of Applicant]
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Part Time Employment Application (Town of Boxborough)

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Completed 15 July 2020

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