Employment application - Town of New Haven
0000Town of New HavenEmployment ApplicationApplicant InformationFull Name:Date:LastFirstM.I.Address:Street AddressApartment/Unit #CityStateZIP CodePhone:EmailDate Available:Social Security No.:Desired Salary:$Position Applied for:Are you a citizen of the United States?YES FORMCHECKBOX NO FORMCHECKBOX If no, are you authorized to work in the U.S.?YES FORMCHECKBOX NO FORMCHECKBOX Have you ever worked for us?YES FORMCHECKBOX NO FORMCHECKBOX If yes, when?Have you ever been convicted of a felony?YES FORMCHECKBOX NO FORMCHECKBOX If yes, explain:EducationHigh School:Address:From:To:Did you graduate?YES FORMCHECKBOX NO FORMCHECKBOX Diploma:College:Address:From:To:Did you graduate?YES FORMCHECKBOX NO FORMCHECKBOX Degree:Other:Address:From:To:Did you graduate?YES FORMCHECKBOX NO FORMCHECKBOX Degree:ReferencesPlease list three professional references.Full Name:Relationship:Company:Phone:Address:Full Name:Relationship:Company:Phone:Address:Full Name:Relationship:Company:Phone:Address:Previous EmploymentCompany:Phone:Address:Supervisor:Job Title:Starting Salary:$Ending Salary:$Responsibilities:From:To:Reason for Leaving:May we contact your previous supervisor for a reference?YES FORMCHECKBOX NO FORMCHECKBOX Company:Phone:Address:Supervisor:Job Title:Starting Salary:$Ending Salary:$Responsibilities:From:To:Reason for Leaving:May we contact your previous supervisor for a reference?YES FORMCHECKBOX NO FORMCHECKBOX Company:Phone:Address:Supervisor:Job Title:Starting Salary:$Ending Salary:$Responsibilities:From:To:Reason for Leaving:May we contact your previous supervisor for a reference?YES FORMCHECKBOX NO FORMCHECKBOX Military ServiceBranch:From:To:Rank at Discharge:Type of Discharge:If other than honorable, explain:Disclaimer and SignatureI certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.Signature:Date: ................
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