Fillable The Town of Newtown is an Equal Opportunity (Town of Newtown, CT)

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The Town of Newtown is an Equal Opportunity (Town of Newtown, CT)

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NEWTOWN MUNICIPAL CENTER
3 PRIMROSE STREET
NEWTOWN, CONNECTICUT 06470
TEL. (203) 270-4246
FAX (203) 270-4205
Email patrice.fahey@newtown-ct.gov
OFFICE OF HUMAN RESOURCES
EMPLOYMENT APPLICATION
The Town of Newtown is an Equal Opportunity Employer. Applicants are considered
for all positions without regard to age, sex, religion, race, color, national origin,
handicap, and marital or veteran status.
Name Date _____
Address City St. _____
Years at present address Driver’s License # Telephone _____
Email address:______________________________________
Previous address _____
_____
Position Applied for Rate of pay expected _____
Have you applied here before? For what position? _____
List any friends/relatives currently working for us _____
_____
Have you ever been discharged by an employer? For what reason?
Are you prevented from lawfully becoming employed in this country because of Visa or
Immigration Status? (Proof of citizenship or immigration status shall be required
upon employment.)
Were/are you a member of the U.S. Armed Forces? Which branch? _____
PERSONAL REFERENCES
Name Phone Number __ __________
Name Phone Number __________
Name Phone Number __________
RECORD OF EDUCATION
College/University Degree
High School Year Graduated
RECORD OF EMPLOYMENT
May we contact your present/most recent employer?
Employer/Address
Position Held Dates of Employment
Reason for Leaving
Employer/Address
Position Held Dates of Employment
Reason for Leaving
Employer/Address
Position Held Dates of Employment
Reason for Leaving
Employer/Address
Position Held Dates of Employment
Reason for Leaving
Please list any qualifications, certifications, special skills:
I certify that all information provided on this application is true, complete and correct to the best of
my knowledge and belief and is made in good faith. I understand that the information is subject to
verification by the Town of Newtown and that incomplete, false, misleading or inaccurate
information may result in the rejection of this application and that false information may result in
my dismissal if employed. I authorize the investigation of all statements contained in this
application.
Applicants Signature Date
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The Town of Newtown is an Equal Opportunity (Town of Newtown, CT)

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Completed 14 July 2020

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