TOWN OF ESSEX AND VILLAGE OF ESSEX JCT
Employment Application
APPLICANT INFORMATION
Last Name
First
M.I.
Date
Apartment/Unit #
City
State
ZIP
Phone
E-mail Address
Desired Salary
Position Applied for
Are you legally authorized to work in the
United States?
YES
NO
Have you ever worked for this company?
YES
NO
If so, when?
EDUCATION
High School
Address
From
To
Did you graduate?
YES
NO
Degree
College
Address
From
To
Did you graduate?
YES
NO
Degree
Other
Address
From
To
Did you graduate?
YES
NO
Degree
REFERENCES
Please list three professional references.
Full Name
Relationship
Company
Phone
( )
Address
Full Name
Relationship
Company
Phone
( )
Address
Full Name
Relationship
Company
Phone
( )
Address
PREVIOUS EMPLOYMENT
Company
Phone
( )
Address
Supervisor
Job Title
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
Company
Phone
( )
Address
Supervisor
Job Title
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
Company
Phone
( )
Address
Supervisor
Job Title
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
MILITARY SERVICE
Branch
From
To
Resume Attached
DRIVERS LICENSE (if you are applying for a job that may involve driving a municipal vehicle)
Do you possess a valid VT Driver’s License:
Yes or No
License Number:
Expiration Date:
License Type:
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Signature
Date
click to sign
signature
click to edit
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