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Town of Wilbraham Employment Application
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Steps
1.
Town of Wilbraham Application for Employment
This section is complete
This section is incomplete
2.
APPLICATION FOR EMPLOYMENT
This section is complete
This section is incomplete
3.
EMPLOYMENT DESIRED
This section is complete
This section is incomplete
4.
APPLICANT INFORMATION
This section is complete
This section is incomplete
5.
EMPLOYMENT HISTORY
This section is complete
This section is incomplete
6.
EDUCATION
This section is complete
This section is incomplete
7.
CERTIFICATIONS / LICENSES / PROFESSIONAL DESIGNATIONS
This section is complete
This section is incomplete
8.
REFERENCES
This section is complete
This section is incomplete
9.
FILE UPLOADS
This section is complete
This section is incomplete
10.
ACKNOWLEDGEMENT AGREEMENT
This section is complete
This section is incomplete
11.
ELECTRONIC SIGNATURE AGREEMENT
This section is complete
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Town of Wilbraham Application for Employment
You are about to begin the Town of Wilbraham's Application for Employment. You will not be able to advance to the next section unless all required fields are completed. You may save your progress if you are unable to complete this application all at once. Your application will be electronically submitted. You will have opportunities to attach additional documents, such as your resume, should you wish to do so. You will also have the opportunity to print a copy of the application for your records, or should you prefer to mailing in a copy.
Technical Note
(This application should be completed using a desktop or laptop PC. Mobile devices are not guaranteed to submit your application properly)
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APPLICATION FOR EMPLOYMENT
PLEASE READ BEFORE FILLING OUT THIS APPLICATION:
The Town of Wilbraham (the “Town”) is an Equal Opportunity Employer. The Town does not discriminate in hiring or employment on the basis of race, sex, color, handicap, national origin, military status, religion, age (as defined by law), ancestry, sexual orientation (as defined by law), genetic information and pregnancy consistent with state and federal law. No question on this form is intended to secure information to be used for such discrimination. This application will be given every consideration, but its receipt does not imply that the applicant will be employed. In processing this employment application, the Town may request that an investigative report be prepared, which may include information as to your character, general reputation, and personal characteristics, obtained through personal interviews with neighbors, friends and associates. In addition, information may be obtained from former employers and educational institutions that you have attended. A credit bureau report may be obtained as part of this application and later for purposes of promotion, reassignment or retention. I understand that should such investigation reveal any false statements made by me, I may be disqualified from employment or subsequently dismissed. I understand that, if I’m hired, subsequent consumer reports may be requested without additional notice to me, in connection with the continuation of my employment (subject to collective bargaining agreements). I understand that an offer for employment may be contingent on the results of a physical examination by a designated physician relative to the essential functions of the job. I hereby acknowledge that I have read the foregoing disclosure and understand it. I authorize the Town to conduct whatever investigation it deems necessary, as permitted by law.
Signature
*
Date
*
Date
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EMPLOYMENT DESIRED
Which position are you applying for?
*
Salary Requirements
*
How were you referred to us?
*
Date Available for Work
*
Are you a United States Citizen, or otherwise eligible for employment in the United States?
*
Yes
No
I understand that any offer for employment is conditional upon satisfactory completion of the verification process as required by the Immigration Reform Act of 1986, and that the Town will hire only those individuals who are legally authorized to work in the United States and present acceptable proof of their lawful employment status and identity.
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APPLICANT INFORMATION
First Name
*
Middle Name
Last Name
*
Email Address
*
Daytime Telephone Number
*
Cellular Telephone Number
*
Address Line 1: Number and Street
*
Address 2: If needed
City
*
State
*
Zip
*
Length of Time at this address: From (date) - To (date)
*
Have you lived at another address within the United States within the past 5 years?
*
Yes
No
Previous Address Line 1: Number and Street
Previous Address Line 2: If Needed
Previous City
Previous State
Previous Zip
Length of Time at this Previous Address: From (date) - To (date)
Previous Address Line 1: Number and Street
Previous Address Line 2: If Needed
Previous City
Previous State
Previous Zip
Length of Time at this Previous Address: From (date) - To (date)
Are you under 18 years of age?
*
Yes
No
If yes, date of birth?
Have you ever been employed by the Town before?
*
Yes
No
If yes, when?
In which department/position?
Do you have an immediate family member (i.e. spouse, parent, sibling, child) working for the Town?
*
Yes
No
If yes, Employee's Name
Department
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EMPLOYMENT HISTORY
Include summer and part-time work, and any periods of unemployment. You may include your verified work performed on a volunteer basis. List only employment within the United States, beginning with your Most Recent.
Company Name
*
Your Job Title
*
Address
*
Supervisor
Phone Number
Nature of Work
*
Time Employed From
*
(Month/Year)
Time Employed To
*
(Month/Year)
Number of Hours Per Week
*
Reason for Leaving
*
May we contact this employer for a reference?
*
Yes
No
Company Name
Your Job Title
Address
Supervisor
Phone Number
Nature of Work
Time Employed From
(Month/Year)
Time Employed To
(Month/Year)
Number of Hours Per Week
Reason for Leaving
May we contact this employer for a reference?
Yes
No
Company Name
Your Job Title
Address
Supervisor
Phone Number
Nature of Work
Time Employed From
(Month/Year)
Time Employed To
(Month/Year)
Number of Hours Per Week
Reason for Leaving
May we contact this employer for a reference?
Yes
No
If you need additional space, please upload an attachment with your Employment History
Were you ever dismissed from a job?
*
Yes
No
If yes, please provide details
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EDUCATION
Name of Elementary School
City/State
Number of years completed
Name of High School
City/State
Number of years completed
Courses Majored In
Did you Graduate?
Yes
No
Type of Degree Earned
Name of College
City/State
Number of years completed
Courses Majored In
Did you Graduate?
Yes
No
In Progress
Type of Degree(s) Earned
Name of Graduate School
City/State
Number of years completed
Courses Majored In
Did you Graduate?
Yes
No
In Progress
Type of Degree(s) Earned
Other
City/State
Number of years completed
Courses Majored In
Did you Graduate?
Yes
No
In Progress
Type of Degree(s) Earned
If you need additional space, please upload an attachment with your Education History
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CERTIFICATIONS / LICENSES / PROFESSIONAL DESIGNATIONS
(List only Certifications, Licenses, and Professional Designations relevant to the requirements of the position for which you are applying)
Type
Issuing Authority
Date of Issuance
Date of Expiration
Type
Issuing Authority
Date of Issuance
Date of Expiration
Type
Issuing Authority
Date of Issuance
Date of Expiration
Type
Issuing Authority
Date of Issuance
Date of Expiration
Type
Issuing Authority
Date of Issuance
Date of Expiration
Type
Issuing Authority
Date of Issuance
Date of Expiration
Type
Issuing Authority
Date of Issuance
Date of Expiration
If you need additional space, please upload an attachment with your Certifications/Licenses/Professional Designations
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REFERENCES
Business References: Please list 3 former managers who directly supervised you
Full Name
*
Relationship
*
Company
*
Phone Number
*
Years Acquainted
*
May we contact this reference?
*
Full Name
*
Relationship
*
Company
*
Phone Number
*
Years Acquainted
*
May we contact this reference?
*
Full Name
*
Relationship
*
Company
*
Phone Number
*
Years Acquainted
*
May we contact this reference?
*
Personal References: List 2 character references who are not related to you and whom you have known for more than 1 year.
Full Name
*
Phone
*
Years Acquainted
*
Full Name
*
Phone
*
Years Acquainted
*
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FILE UPLOADS
Please utilize this section if you wish to include additional documents with your application. You may upload up to 3 files in this section.
File Upload 1
File Upload 2
File Upload 3
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ACKNOWLEDGEMENT AGREEMENT
Thank you for completing this application. Kindly read the following carefully and sign below indicating your understanding and agreement to the following. If you have any questions regarding this statement, please ask them before signing. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liabilities. In the event of employment into a position with the Town, I will comply with all the rules and regulations as set forth in the town’s policies, by-laws, or other communications distributed to employees, which may be changed without notice at the discretion of the Town. Additionally, I authorize the Town to supply my employment record in whole or in part, and in confidence, to any prospective employer, government agency, or other party. I hereby authorize my present and/or former employers, educational institutions, credit bureaus, references, neighbors and friends to disclose to the Town any and all information concerning my previous employment and any other pertinent information they may have, personal or otherwise, and I release all parties from any liability whatsoever resulting from such disclosure. I authorize the Town of Wilbraham 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 Wilbraham any relevant information that may be required to arrive at an employment decision. I understand that the information released is for the Town of Wilbraham’s use only. I hereby voluntarily release, discharge and exonerate the Town of Wilbraham, 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 Wilbraham. I understand that all appointments are probationary for a period of six (6) months and that I must demonstrate my ability for continued employment. 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. I understand that any employment offer by the Town is conditional upon my ability to establish employment eligibility and identity under the Immigration Reform and Control Act of 1986 within three days of the date of hire. I represent that I have read and fully understand the foregoing and seek employment under these conditions. I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably. 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 and agree that if I am offered employment, it will be as an employee-at-will and that no employment contract rights have been created. (This statement does not necessarily apply to those employees who, if hired, will be members of a collective bargaining agreement). I also understand and agree that my employment may be terminated at any time with or without cause (subject to the collective bargaining agreement, if applicable), and with or without advance notice at the option of either the Town or myself. Any agreement for employment must be in writing and must expressly state that I have been selected for employment by the Town of Wilbraham, and be signed by an authorized representative of the Town.
I hereby acknowledge that I have read the above statement and understand it.
Signature of Applicant
*
Date
*
Date
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ELECTRONIC SIGNATURE AGREEMENT
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Agreement Acceptance
*
I AGREE
I DO NOT AGREE
Applicant Signature
*
Date
*
Date
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