Fillable Town of Rockland Application for Employment (Town of Rockland)

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Town of Rockland Application for Employment (Town of Rockland)

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Country of origin: US
File type: PDF

U.S.A. forms for Town of Rockland

BROWSE TOWN OF ROCKLAND (MA) FORMS

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Town of Rockland Application for Employment
242 Union St, Rockland, MA 02370
ALL APPLICATIONS TO BE RETURNED TO THE HUMAN RESOURCES OFFICE
(Please Print or Type Clearly)
Applicants are considered for all positions without regard to race, color, religion, sexual orientation,
gender identity, national origin, age, marital or veteran status, or the presence of a non-job-related
medical condition or handicap.
Position(s) Applied For:
Date of Application:
Referred by:
Friend
Relative
Walk-In
Other:
Name: __________________________________________________________________________________
Last First Middle
Address: ________________________________________________________________________________
Number Street City State Zip Code
Phone:
E-mail:
If you are under 18, can you furnish a work permit? Yes No
Have you filed an application with the Town before? Yes No Date:
Have you been employed by the Town before? Yes No Date:
Are you related to any employees within the Town? Yes No Name:
Are you currently employed? Yes No
Are you a U.S. Citizen? Yes No
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
On what date are you available to work?
Availablity restrictions?
Type of work sought: Full-time Part-time Shift work Temporary
Education
High School:
Address:
Did you graduate? Yes No
Course of study:
Degree received:
College/University:
Address:
Did you graduate? Yes No
Course of study:
Degree received:
Post-Graduate:
Address:
Did you graduate? Yes No
Course of study:
Degree received:
Employment Experience
Start with your present or last job. Include military service assignments and volunteer activities. You may exclude
organization names which indicate race, color, religion, gender orientation, national origin, age, marital, or veteran status.
Employer:
Phone:
Address:
Supervisor:
Job Title:
Dates employed: to
Duties performed:
Reason for leaving:
May we contact this employer? Yes No
Employer:
Phone:
Address:
Supervisor:
Job Title:
Dates employed: to
Duties performed:
Reason for leaving:
May we contact this employer? Yes No
Employer:
Phone:
Address:
Supervisor:
Job Title:
Dates employed: to
Duties performed:
Reason for leaving:
May we contact this employer? Yes No
Military Service
Branch:
Dates served: to
Rank when discharged:
Type of discharge:
If other than honorable, please provide explanation:
Specialized Skills
Please summarize any special skills and qualifications acquired from employment or other experience:
APPLICANT’S STATEMENT
The information provided in this application for employment is true and complete to the best of my knowledge.
In the event of employment, I understand that false or misleading information given in my application or
interview(s) may result in discharge.
I authorize investigation of all statements contained in this application and the release of any pertinent
information regarding my education, past employment history and background. I authorize the Town of
Rockland to obtain any information from schools, employers or individuals relating to my activities. This
information may include, but is not limited to: Academics, achievement, performance, attendance, personal
history and discipline. Further, I hereby authorize all references, persons, schools, my current employer (if
applicable) and previous employers and organizations named in this application, unless otherwise stated, to
provide the Town of Rockland any relevant information that may be required to arrive at an employment
decision. I understand that the information released is for the Town of Rockland’s use only.
I hereby voluntarily release, discharge and exonerate the Town of Rockland, its agents and representatives, and
any person so furnishing information from any and all liabilities of every nature and kind arising out of the
furnishing or inspection of such documents, records and other information or the investigations made by or on
behalf of the Town of Rockland.
I understand that all appointments are probationary and that I must demonstrate my ability for continued
employment. I understand that, if appointed, my employment will be at-will, for an indefinite period, and can be
terminated at any time by the Town, unless otherwise stated in a collective bargaining agreement which covers
the position to which I am appointed. I also understand that I must be available from time to time to work
outside normal business hours, as the needs of the department require.
If required for the position I am seeking. I agree to take a physical examination, which may include testing for
drugs or a psychological examination, as required, and recognize that any offer of employment may be
contingent upon the results of such an examination.
In the event of employment, I understand that false or misleading information given in my application or
interview(s) may result in discharge. I understand, also that I am required to abide by all rules and regulations
of the Company. Further, I understand that any employment offer by the Town is conditional upon my ability to
establish employment under the Immigration Reform and Control Act of 1986 within three (3) days of the date
of hire.
I represent that I have read and fully understand the foregoing and seek employment under these conditions.
Signature: ______________________________ Date: ____________________
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“Discrimination against any person in any practice or procedure in advertising, recruitment, referrals, testing,
hiring, transfer, promotion or any other term, condition or privilege of employment which limits or adversely
affects employment opportunities, because of political or religious opinions, or affiliations, or because of race,
color, sex, gender, orientation, national origin, marital status, pregnancy, parenthood, age or handicap which
is unrelated to the person’s occupational qualifications or any other non-merit factor which is not a bona fide
occupational qualification is prohibited.”
It is unlawful in Massachusetts to require a lie detector test as a condition of employment or continued
employment. An employer who violates that law shall be subject to criminal penalties and civil liabilities.
APPLICANT DATA RECORD
Applicants are considered for all positions, and employees are treated during employment without regard to
race, color, religion, gender orientation, national origin, age, marital or veteran status, medical condition or
handicap.
As employers/government contractors, we comply with government regulations and affirmative action
responsibilities.
Solely to help us comply with government record keeping, reporting and other legal requirements, please fill
out the Applicant Data Record. We appreciate your cooperation.
This data is for periodic government reporting and will be kept in a Confidential File separate from the
Application for Employment.
Position(s) Applied For:
Date of Application:
Referred by:
Friend
Relative
Walk-In
Advertisement
Other:
Name: __________________________________________________________________________________
Last First Middle
Address: ________________________________________________________________________________
Number Street City State Zip Code
Phone:
E-mail:
FOR HUMAN RESOURCES DEPARTMENT USE ONLY
Position(s) applied for is open: Yes No
Arrange interview: Yes No
Employed: Yes No
Remarks:
Job Title:
Salary:
Department:
Signature:
Date:
Further notes:
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Town of Rockland Application for Employment (Town of Rockland)

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Completed 25 February 2021

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