Town of Braintree
Human Resources Department
1 JFK Memorial Drive, Braintree, MA 02184
Phone: 781-794-8260 Fax: 781-794-8269
Application for Employment
The Town of Braintree is an equal opportunity/affirmative action employer and does not discriminate against any applicant because of race, color, religion, sex, marital
status, genetics, national origin, age, disability, sexual orientation or any other class protected by federal, state or local law. Any person who needs assistance in fully
participating in the application process should contact the Town of Braintree Human Resources Department.
I. Contact Information
Name Date
Address # and Street City and State Zip Code
Telephone Email Address
II. Position Applying For (Please specify position title or job category)
How did you hear about the position?
Have you ever been employed by the Town of Braintree? When? What department?
III. Education
School Name, Address, City, State Years Attended Degree
High School
Graduate School
Trade, Business,
Night Courses
Military Service,
Other Training
IV. Licenses (Please list all licenses you possess that are relative to the position you seek). A valid license is a condition of employment, where required.
Do you have a valid driver’s license (Class D Auto)? Yes _____ No _____ If yes, enter expiration date _______________
Do you have a valid CDL license (Class A or B)? Yes _____ No _____ If yes, enter expiration date _______________
What other valid licenses or certifications do you possess (job related)?
V. Employment Eligibility
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration
status will be required upon employment
. Yes _____ No _____
VI. Special Skills
Please list any other skills or abilities you feel are relevant:
VII. Employment History
Please account for the last 3 positions you have held. Start with your present or last employer. You may include military service and any verifiable
work performed as an intern or volunteer. You (
) may ( ) may not contact my present employer.
Employer Address
Telephone Title
Supervisor Dates Worked
Reason for Leaving
Description of Primary duties:
Employer Address
Telephone Title
Supervisor Dates Worked
Reason for Leaving
Description of Primary duties:
Employer Address
Telephone Title
Supervisor Dates Worked
Reason for Leaving
Description of Primary duties:
VIII. Business References {a minimum of 3 references is required}
Address Phone R
Name/Title Address Phone Relationship
Address Phone Relationship
IX. Criminal History
A. The Town of Braintree requires a Criminal Offense Record Inquiry (CORI check) on all prospective employees for certain
B. A conviction will not necessarily be a bar to employment.
X. Employment of Minors
The Town of Braintree is subject to certain child labor provisions regarding the employment of persons under the age of 18. Further,
an Employment Permit or Educational Certificate may be required, depending on your age.
Are you under age 18? If yes, please indicate your age:
XI. Medical Information
All offers of employment are conditional upon the satisfactory completion of a Pre-Employment Physical. Satisfactory fitness to
perform the essential duties of the position is a condition of employment.
XII. Pre-Employment Drug Testing
All offers of employment are conditional upon the satisfactory completion of a pre-employment drug test, where required.
Satisfactory completion of a required drug or alcohol test is a condition of employment as outlined in the Drug and Alcohol Testing
Policy of the Town of Braintree.
XIV. Signature
A. I understand that acceptance of this application by the Town of Braintree does not imply that I will be employed. (Exceptions to A
is an employee filling out this application for promotional purposes only.)
B. The information that I have provided is true and complete. I understand that misrepresentation or omission of any fact in my
application, resume, or in any other materials or as provided during interviews, can be justification for refusal of employment or
can be justification for termination from employment, if employed.
C. I understand that any offer of employment that I receive from the Town of Braintree is contingent upon my successful completion
of the pre-employment screening process including but not limited to the Town of Braintree receiving satisfactory references, a
satisfactory criminal history and Criminal Offense Record Inquiry if required, satisfactory verification of driver’s license or
certifications where required and satisfactory completion of any required post-offer pre-employment drug test or physical
D. In processing my application for employment, the Town of Braintree may verify all of the information provided by me concerning,
among other things, my prior employment or military record, education, character, general reputation and personal characteristics.
E. I authorize the Town to take whatever steps deemed necessary to obtain information regarding my qualifications for employment
including contacting my present and former employers, by contacting individuals listed as business, educational or personal
references, and by contacting other individuals to provide or further clarify information about me.
F. I hereby release my present and former employers and all individuals contacted for factual information about me from any and all
liability for damages arising from furnishing the requested information.
G. If employed by the Town of Braintree, I understand that as a condition of employment, I may be required to furnish additional or
updated medical information, that I may be required to undergo a physical examination, that I may be subject to drug and/or
alcohol testing, that the Town may request a Criminal Offense Record Inquiry (CORI check) on me, investigate my driving record
or verify my license(s) or certification(s) as required for employment at any time during my employment. As a condition of
employment an employee may be required to provide additional or updated information especially if this employee has been on
workers comp with another employer and may require both drug testing and an employment physical in order to allow us to have
the necessary information for making a proper decision or reasonable accommodations, if necessary.
H. I understand that the Town of Braintree is an at-will employer. If employed, I understand that my employment may be terminated
with or without cause at any time unless there is an applicable bargaining unit contract provision.
My Signature Certifies That I Have Read And Agree With The Above Statements And All Statements Contained In This Application
For Employment.
plicant Name (Please Print)
plicant Signature Date
Please com
plete this information for our records and required reporting. Please submit form with your completed
application. Thank you.
Applicant Nam
last first middle initial
Applicant Address:
P.O. Box, street, town, state &
zip code
Position applyi
ng for:
Sex: M
Please select one of the following:
1. White: (not of Hispanic origin) All persons having origins in any of the original peoples of Europe, North Africa,
or the Middle East.
Black: (not of Hispanic origin) All persons having origins in any
of the Black racial groups of Africa.
3. Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or
origin, regardless of race.
Asian or Pacific Islander: All persons having origins in any
of the original peoples of the Far East, Southeast
Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for exam
China, India, Japan, Korea,
the Philippine Islands, and Samoa.
American Indian or Alaskan Native: All persons having origins in any of the original peoples of North Am
and who m
aintain cultural identification through tribal affiliation or community
6. Cape Verdean: All persons who are descendants of anyone born in the Cape Verde Islands
7. Unknown