Fillable Village Of Oregon Application Fillable

Fill Online, Printable, Fillable, Blank Village Of Oregon Application Fillable Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Village Of Oregon Application Fillable

On average this form takes 33 minutes to complete

The Village Of Oregon Application Fillable form is 4 pages long and contains:

  • 0 signatures
  • 22 check-boxes
  • 120 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Village of Oregon is an Equal Opportunity Employer 1
117 Spring Street • Oregon, WI 53575 • Phone: 608.835.3118 • Fax: 608.835.6503
www.vil.oregon.wi.us
Applicant Information
Full Name:
Date:
Last First
Middle
Maiden/Previous
Address:
City
State
ZIP Code
Phone:
Email:
Position Applied for:
Have you worked for the Village before?
YES
NO
If yes, explain:
Do you have a valid Driver’s License (DL)?
YES
NO
DL Number:
Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the U.S.?
YES
NO
Are you currently employed?
YES
NO
May we inquire with your current employer?
YES
NO
Have you ever been convicted or do you have any pending charges for any violations of Municipal or County
Ordinance, or State or Federal Laws?
YES
NO
If “Yes”, then please provide all information related to pending charges or the conviction of the offense, including, but not limited to, the date of the incident,
the date of the conviction or filing of the charge, a summary of the factual circumstances of the incident, the location and prosecuting agency and
investigating agency, and the specific violation subject to the pending charge or the conviction. You are informed by the Village that any pending charge or
conviction (including pleas) alone will not automatically disqualify you from employment unless the pending charge or conviction substantially relates to the
employment positon that you applied for with the Village or if the conviction or any court order prohibits you from performing a function of the job or if the
Village’s investigation of the underlying facts demonstrates you are unfit for the position. This information will only be used as permitted by law. Write a
short narrative of the circumstances on the addendum provided at the end of the application. Start with the most recent incident. Additional space has
been provided on page 4 “Addendum to Village of Oregon Application for Employment: Information Related to Pending Charges or Convictions, if any”
attached to this application.
Education
High School:
Address:
Studies:
Credit hours
(if you did not graduate)
From:
To:
Did you graduate?
YES
NO
Diploma/GED:
College:
Address:
Studies:
Credit hours
(if you did not graduate)
From:
To:
Did you graduate?
YES
NO
Degree:
Please list other college education / vocational training / volunteer work or certification relevant to the position
Village of Oregon is an Equal Opportunity Employer 2
References
Please list three professional references, not related to you, whom you have known at least one year.
Full Name: Years Known:
Company: Email:
Address: Phone Number:
Full Name: Years Known:
Company: Email:
Address: Phone Number:
Full Name: Years Known:
Company: Email:
Address: Phone Number:
Previous Employment
Please list your previous employment for the past ten (10) years. Attach additional sheets as necessary.
Employer:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES
NO
Email: ___________________________
Employer:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES
NO
Email: ___________________________
Village of Oregon is an Equal Opportunity Employer 3
Previous Employment (cont.)
Employer:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES
NO
Email: __________________________
Authorization, Release, Certification and Signature
I certify that information on this application is true, complete, and correct, and I authorize investigation of the assertions I
have made to the Village of Oregon during this application process. Because of the importance to the public of the Village
hiring high quality candidates to serve the public’s interests with integrity and high ethical standards, I understand that any
false or misleading statement, omission, or misrepresentation concerning requested information on this application or
provided by me during the hiring process shall be a sufficient basis for rejection of my application or, if employed, my
termination.
I understand that my pursuit of employment may be contingent upon the satisfactory completion of any or all of the
following: interviews, skills or abilities testing, drug screening, background check, and investigation of my character,
personal history, work record and references, and medical examinations. I consent to this process including a post-
conditional offer pre-employment health examination and such future examinations as may be required by the Village.
I understand that I may be asked to sign a release and indemnification agreement regarding the background screening
process. I understand that I may negotiate the terms of that agreement and that I will not be considered for employment if
an agreement is not reached.
I understand this application will be considered inactive after thirty days unless otherwise decided by the Village.
I certify I have read (or have read to me) and understand this authorization and certification.
Signature:
Date:
Please return application to: Oregon Area Senior Center
219 Park Street
Oregon, WI 53575
Email: rbrickner@vil.oregon.wi.us
If you need an accommodation at any time during the recruitment or employment process, please inform us of your
needs. The Village of Oregon is an Equal Opportunity Employer and provides equal opportunities for all qualified
individuals. We do not discriminate against employees or applicants because of their age, race, gender, gender identity,
sexual orientation, religion, color, creed, national origin, veteran status, unemployment status, disability, or any other
classification regarded as protected under state or federal law.
Village of Oregon is an Equal Opportunity Employer 4
Addendum to Village of Oregon Application for Employment:
Information Related to Pending Charges or Convictions, if any
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Village Of Oregon Application Fillable

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 19 April 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document