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Collects applicant personal information, work authorization eligibility, employment desired details, education history, special study or training skills, U.S. military experience, driver’s license information, former employers history, and three professional references. 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This policy shall be applied without regard to any individual’s race, color, gender, age, religion, national origin, physical or mental disability, marital status, pregnancy, sexual orientation, political affiliation, veteran status or other legally protected status.  \nPERSONAL INFORMATION DATE  \n\n| NAME: (LAST, FIRST, MIDDLE) |  |  | Are you a US citizen or legally authorized to work in this country?\u003Cbr>YES   NO   |  |  |\n| --- | --- | --- | --- | --- | --- |\n| PRESENT OR MAILING ADDRESS: |  | CITY: |  | STATE: | ZIP CODE: |\n| PERMANENT ADDRESS: |  | CITY: |  | STATE: | ZIP CODE: |\n| PHONE NUMBER:( ) | EMAIL ADDRESS: |  |  | REFERRED BY: |  |\n\nEMPLOYMENT DESIRED  \n\n| POSITION: | DATE YOU CAN START: | SALARY DESIRED: |  |\n| --- | --- | --- | --- |\n| HAVE YOU EVER APPLIED WITH THE TOWN OF EPPING BEFORE? | WHERE? |  | WHEN? |\n\nEDUCATION HISTORY  \n\n| LEVEL OF EDUCATION | NAME & LOCATION OF SCHOOL | YEARS ATTENDED | GRADUATE? | STUDIES OR MAJOR |\n| --- | --- | --- | --- | --- |\n| HIGH SCHOOL |  |  |  |  |\n| COLLEGE |  |  |  |  |\n| TRADE, BUSINESS OR OTHER SCHOOL |  |  |  |  |\n\nGENERAL INFORMATION  \n\n| SUBJECTS OF SPECIAL STUDY OR SPECIAL TRAINING OR SKILLS, INCLUDING LICENSES AND CERTIFICATIONS: |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |\n| US MILITARY EXPERIENCE (YEARS & BRANCH OF SERVICE) |  |  | RANK/RATE ATTAINED: |  | HONORABLE DISCHARGE? |  |  |\n|  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |\n| DRIVER'S LICENSE NUMBER: | STATE: | TYPE: | EXPIRATION DATE: | RESTRICTIONS: |  | VALID? |  |\n|  |  |  |  |  |  | YES | NO |\n\n\n| TOWN OF EPPING, NH | APPLICATION FOR EMPLOYMENT-PAGE 2 |\n| --- | --- |\n| APPLICANT NAME (LAST, FIRST, MIDDLE) |  |\n\nFORMER EMPLOYERS (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH MOST RECENT/PRESENT EMPLOYER) .  \n\n| DATE\u003Cbr>MONTH AND YEAR | NAME & ADDRESS OF EMPLOYER | POSITION | LAST SALARY | REASON FOR LEAVING |\n| --- | --- | --- | --- | --- |\n| FROM: |  |  |  |  |\n| TO: |  |  |  |  |\n| FROM: |  |  |  |  |\n| TO: |  |  |  |  |\n| FROM: |  |  |  |  |\n| TO: |  |  |  |  |\n| FROM: |  |  |  |  |\n| TO: |  |  |  |  |\n\nREFERENCES: (PROVIDE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR)  \n\n| NAME | ADDRESS | TELEPHONE \\# | YEARS KNOWN |\n| --- | --- | --- | --- |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n| CERTIFICATION OF STATEMENTS MADE AND AUTHORIZATION FOR RELEASE OF INFORMATION\u003Cbr>I certify that the statements on this application are true and complete to the best of my knowledge and I understand that, omissions or misrepresentations may result in the rejection of this application or my discharge.\u003Cbr>I authorize investigation of all statements I have made herein. I further authorize the people I have listed as references and employerson this application to an authorized representative of the Town of Epping any and all information concerning my previous employment and any pertinent information they may have about me, personal or otherwise, including the release of my personnel jacket information. I hereby release said employers and references from all liability for any damage that may result from utilization of such\u003Cbr>information.\u003Cbr>Further, I understand that, if hired, to the extent permitted by law, my employment is at will, meaning that it is for no definite period and, regardless of the date of my payment of my wages, may be terminated at any time without any previous notice and for any reason. This application will only be valid for 30 days; thereafter, I understand I will have to complete a new one.\u003Cbr>SIGNATURE   DATE   |  |  |  |","cbCaiqsb3me6UcxE","https://ap.wps.com/l/cbCaiqsb3me6UcxE","pdf",229660,"English","# Personal Information\n# Employment Desired\n# Education History\n# General Information\n# Former Employers\n# References\n# Certification and Authorization","[{\"question\":\"What information does the application request for personal details?\",\"answer\":\"The form collects name, date, present or mailing address, permanent address, phone number, email address, and whether the applicant is a U.S. citizen or legally authorized to work, plus referral information.\"},{\"question\":\"What sections are included for qualifications and background?\",\"answer\":\"It includes employment desired details, education history, subjects of special study or training and skills, U.S. military experience, and driver’s license information.\"},{\"question\":\"What does the certification and authorization section require?\",\"answer\":\"The applicant must certify statements are true and authorize investigation of information and reference checks, including release of personnel jacket information, and acknowledge at-will employment and that the application is valid for 30 days.\"}]","TOWN OF EPPING, NH Application For Employment | PDF",1789823741]