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2.
Personal Information
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3.
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4.
Education
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5.
Employment History
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6.
References
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7.
Disclaimer & Signature
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Personal Information
First Name
*
Last Name
*
Address1
*
Address2
City
*
State
*
Zip
*
Phone Number
*
Email Address
*
Have you ever been convicted of a violation of the law other than a minor traffic violation?
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Are you eligible to work in the United States?
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Position Information
Which position are you applying for?
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Type of employment desired
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Salary desired
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How did you hear about the position?
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Education
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Employment History
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Company
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Position
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Supervisor
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Phone Number
*
May we contact your previous supervisor for a reference?
*
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Address
*
Responsibilities
*
Employed From - To (Date)
*
Salary
Company
*
Position
*
Supervisor
*
Phone Number
*
May we contact your previous supervisor for a reference?
*
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Address
*
Responsibilities
*
Employed From - To (Date)
*
Salary
Company
Position
Supervisor
Phone Number
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Address
Responsibilities
Employed From - To (Date)
Salary
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References
Please list three professional references.
Full Name
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Relationship
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Company
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Phone Number
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Full Name
*
Relationship
*
Company
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Phone Number
*
Full Name
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Relationship
*
Company
*
Phone Number
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Disclaimer & Signature
I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.
I understand that the Town of Middleburg may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.
Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
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