PREVIOUS EMPLOYMENT: (Use additional sheets if necessary to describe all previous employment)
Employer: _____________________________________ Address _________________________________________________
(Street) (City) (State)
Name and Title of
Telephone______________________ Kind of Business_________________________ Immediate Supervisor__________________
(Include Area Code)
Employed From _______________________ to _________________________ Job Title __________________________________
(Mo., Yr.) (Mo., Yr.)
Duties
Performed____________________________________________________________________________________________________
Starting Salary_________________ Final Salary___________________ Reason for Leaving__________________________________
GENERAL:
Are you authorized to work in the United States? ____ Yes ____ No (Proof of eligibility to work in the U.S. will be required upon employment.)
Are you 18 years old or older? _____ Yes _____ No How did you happen to contact the Town/City?____________________________
Are you available to work full-time ______ part-time ______ temporary ______? If part-time, indicate maximum hours per week______
What position are you applying for? ____________________________________________ Starting salary desired
__________________
Can you perform the essential functions of the job with or without reasonable accommodation? ______ Yes ______ No
Are you currently on layoff or leave from another employer? ______ Yes ______ No
NOTICE: PLEASE READ BEFORE SIGNING
If I am hired, I agree to abide by the rules and policies of the Town of Hopkinton.
I understand that if I am hired, my employment will be for no definite period, and that my employment and compensation can be
terminated with or without cause and without notice, at any time, at the option of either the Town or me.
I authorize all persons, companies, prior employers, schools, credit bureaus, and government agencies to supply any information
concerning my background, education, and employment, and release all parties from all liability for any damage that may result from
furnishing same to you. I also release the Town of Hopkinton and its agents from all liability from damages arising from this research of
my background.
I certify that the information contained in this application is complete and correct to the best of my knowledge and understand that
falsification of this information is grounds for dismissal in accordance with Town policy.
I certify that all of the information that I provide on this application or in any interview will be complete, true, and accurate. I
understand that if I am hired, and any such information is later found to be incomplete, false, or misleading in any respect, I may be
discharged.
I have read the above Notice Section or have had someone read or explain to me, and I fully understand it.
______________________________________ _________________________________________ __________________________
(Print Name) (Signature) (Date)
EDUCATION: Degree Received Type of Degree
Name City/State Yes or No Diploma or GED Major
High School _________________________ _______________________ _______ ______________ ___________
College _________________________ _______________________ _______ ______________ ___________
Other _________________________ _______________________ _______ ______________ ___________
Trade School _________________________ _______________________ _______ ______________ ___________
Commercial courses completed (Include skills, typing, shorthand, business machines, personal computers, etc.)___________________
____________________________________________________________________________________________________________
CONVICTION INFORMATION:
Have you ever been convicted of a crime (including pleading guilty or no contest) that has not been annulled by a court, except for minor
traffic violations? ______ Yes ______ No (If yes, please fill in information below.)
Conviction information will not necessarily bar an applicant from employment.
Date Reason Disposition of Case Place
1. __________________ ______________________________ ____________________________________
2. __________________ ______________________________ ____________________________________
3. __________________ ______________________________ ____________________________________
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