Fillable Village of Northport Employment Application (Incorporated Village of Northport, NY)

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Village of Northport Employment Application (Incorporated Village of Northport, NY)

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The Village of Northport Employment Application (Incorporated Village of Northport, NY) form is 2 pages long and contains:

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  • 6 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Incorporated Village of Northport, NY

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Village of Northport
-Incorporated in 1894-
224 Main Street
Northport, New York 11768
Phone: (631) 261-7502 Fax (631)261-7521
Employment Application
Name: _____________________________________________________________
Last First Middle Initial
Address: ___________________________________________________________
Street Town Zip Code
Home Phone: ________________________ Cell Phone: _____________________
Social Security No: _______-_______-_______ Driver’s License No: ___________
Name of Current School: ______________________________________________
Grade Level as of July 1
st
: High School (9) (10) (11) (12) College (1) (2) (3) (4) (5)
Position Desired: ____________________________________________________
Employment Desired: Seasonal ( ) Full-Time ( ) Part-Time ( ) Other ( )
Dates Available: _______-_______-_______ until _______-_______-_______
Certifications: (include dates of expiration): ________________________________
__________________________________________________________________
Previous Employment/Experience: ______________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
-OVER-
1. Reference Name: __________________________________________________
Reference Address: ___________________________________________________
Reference Phone: _____________________ Relationship: ____________________
2. Reference Name: __________________________________________________
Reference Address: ___________________________________________________
Reference Phone: _____________________ Relationship: ____________________
2. Reference Name: __________________________________________________
Reference Address: ___________________________________________________
Reference Phone: _____________________ Relationship: ____________________
In case of emergency, please notify:
Contact Name: ______________________________________________________
Contact Number: _______________________Relationship: ___________________
I hereby certify that all answers to these questions and all statements on this
application are true and I agree and understand that any misstatement of material facts
contained in this application may cause forfeiture upon my part of all rights to any
employment sought hereunder.
Signature: _____________________________________ Date: ________________
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Village of Northport Employment Application (Incorporated Village of Northport, NY)

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Completed 19 January 2021

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