TOWN OF DOUGLAS
APPLICATION FOR EMPLOYMENT
Referral Sources:
PERSONAL
Mailing Address
(if different)
GENERAL INFORMATION
If employed and you are under 18, can you furnish a work permit?
Have you filed an application in the Town of Douglas before?
Have you ever been employed in the Town of Douglas before?
Are you employed in the Town of Douglas now?
May we contact you present employer?
Can you, after employment, submit verification of your legal right to work in the United States?
EDUCATION, TRAINING, & EXPERIENCE
Source Name & Location of School Diploma/Degree Certificate
High School
Business, Technical, or
Correspondence Schools,
College & Graduate Schools:
Special Courses, Training :
Manual: List licenses you possess (Motor Vehicle Operator, CDL, Class I II III, Hoisting, Engineer, etc.)
Clerical: List office machines you can operate (computer/programs, fax, etc.)
The Town of Douglas is an Equal Opportunity Employer. Applicants are considered for all positions without regard to race,
color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation or any other legally protected status.
Position(s) Applied for:
Date of Application
salary desired:
advertisement
friend / relative
employment agency
other
job posting
walk-in
Last Name
First Name
Initial
Address
City
State
Zip Code
Address
City
State
Zip Code
Phone Number
email
yes
no
yes no
If yes, give date:
If yes, give date:
noyes
yes
no
noyes
yes
no
In case of emergency notify:
Enter numbers only, no dashes
Print Form
ADDITIONAL INFORMATION
OtherQualifications:
Please list any other skills or qualifications you may have acquired from other employment or experience.
REFERECES
Please list the names of three (3) persons, not related to you, whom you have known at least one
year.
1.
2.
3.
AGREEMENT
The information provided in this application for employment is true and complete to the best of my knowledge. In the even of
employment, I understand that false or misleading information given in my application or interview may result in discharge.
Further, if hired I agree to take a physical exam as required under the Town's Personnel Bylaw if applicable to my employment.
I understand that any offer of employment may be contingent upon the physician's opinion. I also understand
that any employment offer is conditional on my ability to establish eligibility under the Immigration Reform and Control Act
of 1986. I authorize investigation of all statements contained in this application and the release of information regarding
education and past employment.
Name Address Phone
Yrs. Known
Name
Name Address
Address Phone
Phone
Yrs. Known
Yrs. Known
Signed By
Date
The Town of Douglas is an Equal Opportunity Employer. Applicants are considered for all positions without regard to race,
color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation or any other legally protected status.
For Phone #'s, enter numbers only, no dashes