Fillable Town of Old Lyme APPLICATION FOR EMPLOYMENT (Town of Old Lyme)

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Town of Old Lyme APPLICATION FOR EMPLOYMENT (Town of Old Lyme)

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The Town of Old Lyme APPLICATION FOR EMPLOYMENT (Town of Old Lyme) form is 6 pages long and contains:

  • 1 signature
  • 19 check-boxes
  • 95 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Old Lyme

BROWSE TOWN OF OLD LYME (CT) FORMS

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11/09/2021
PAGE 1 OF 6
Town of Old Lyme
52 Lyme Street
Old Lyme, CT 06371
APPLICATION FOR EMPLOYMENT
The Town of Old Lyme (“Town”) is an equal opportunity employer, dedicated to a policy of nondiscrimination in
employment on any basis prohibited by law. The Town considers applicants for all positions without regard to race,
color, religion, gender, national origin, age, disability, marital status, military/ veteran status, sexual orientation,
gender identity/expression, genetic information, hair texture/protective
hairstyles or any other characteristic
protected by applicable local, federal, or state law.
PERSONAL INFORMATION
How did you first learn about the position for which you are applying?
Newspaper Internet Other
EMPLOYMENT DESIRED
Position(s) applied for:
Date available to begin work:
Please indicate your availability:
Are you able and willing to work overtime if your job requires it?
Are you able and willing to travel if your job requires it?
Last Name
First Name
Middle
Address
City
State
Zip Code
Social Security Number
Email Address
Cell Phone
Home Phone
Work Phone
Are you a US Citizen or alien authorized to work in the United States?
Yes
Are you prevented from lawfully becoming employed in this country
because of VISA or immigration status?
Yes
If employment is offered, can you produce documentation required
by law to establish work authorization and identity?
Yes
Yes No
Yes No
Full-Time Part-Time
11/09/2021
PAGE 2 OF 6
SKILLS AND QUALIFICATIONS
Provide a list of computer operating systems and programs that you have experience with and indicate your level of expertise:
Describe other skills and qualifications you have relevant to the position(s) for which you are applying:
Have you ever been dismissed, involuntarily terminated, or forced to resign from employment?
Yes No
If yes, please explain:
11/09/2021
PAGE 3 OF 6
Name/Address of School
Course of Study
Diploma/Degree
EDUCATION AND TRAINING
Secondary/High
School
College/University
Scholastic Average at Each University:
Academic Scholarships/Awards:
Describe any licenses, certifications, and/or specialized training you have received:
Have any license or certification you have held been surrendered, suspended, or revoked for any reason? If yes, please explain.
Yes No
ADDITIONAL INFORMATION
Provide any additional information you feel may be helpful in considering your application:
11/09/2021
PAGE 4 OF 6
EMPLOYMENT HISTORY
Provide your complete employment history for the past 15 years. Do not omit any jobs. Include any job-related military
service assignments and volunteer activities. If you will require additional space, please print additional copies of page 5
or continue on the back of the page.
Employer From To
Address Phone
Job Title
Duties & Accomplishments
Supervisor's Name & Title
Reason for Leaving
Employer From To
Address Phone
Job Title
Duties & Accomplishments
Supervisor's Name & Title
Reason for Leaving
Employer From To
Address Phone
Job Title
Duties & Accomplishments
11/09/2021
PAGE 5 OF 6
EMPLOYMENT HISTORY CONT.
Employer From To
Address Phone
Job Title
Duties & Accomplishments
Supervisor's Name & Title
Reason for Leaving
Employer From To
Address Phone
Job Title
Duties & Accomplishments
Supervisor's Name & Title
Reason for Leaving
Employer From To
Address Phone
Job Title
Duties & Accomplishments
11/09/2021
PAGE 6 OF 6
REFERENCES
Name Address
Telephone Number(s)
1
2
3
EMERGENCY CONTACT
Name
Relationship
Telephone Number(s)
1
2
AT-WILL EMPLOYMENT DISCLAIMER AND APPLICANT'S AGREEMENT AND
CERTIFICATION
I certify that the information provided in this application is true and accurate to the best of my knowledge.
I understand the use of this application form does not indicate there are any open positions and does not in any way
obligate the Town ("Employer").
I understand that should I be granted an interview, no representations that may be made during the interview are to be
construed as creating an obligation, promise, or contract on behalf of the Town. Further, in consideration of employment,
I agree to conform to the policies and procedures of the Town, as they may from time to time be implemented or revised,
and that my employment and compensation can be terminated with our without cause or notice, at any time and for any
lawful reason or for no reason at all at the option of either the Town or myself. It is futher understood that this "at-will"
employment relationship may not be changed by any written document or by conduct unless the First Selectman of the Town
specifically acknowledges such change in writing. I understand that no supervisor, member of management, or any other
employee of the Town has any authority to make a commitment of guaranteed or continued employment to me, and no
document or publication of this Employer should be interpreted to make such a guarantee.
I understand that false or misleading information given in my application, resume, interview(s), or during the course of my
employment may result in withdrawal of a job offer or discipline up to and including termination of employment, whenever
the omission or falsehood is discovered.
I understand that acceptance for employment shall depend on satisfactory replies from my references and other
background checks. In the event I receive a job offer, I also understand that I may be subject to a drug test and/or
medical examination and that I must pass before I commence work.
I have read, understand, and agree to the foregoing.
Signature of Applicant
Date
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Town of Old Lyme APPLICATION FOR EMPLOYMENT (Town of Old Lyme)

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Completed 15 November 2021

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