[Town of Somers] Somers - Employment Application

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Town of Somers, NY, Application for Employment (An Equal Opportunity Employer)

Personal Information

Date

First Name

Middle Name

Last Name

Address

Mailing Address (if different)

Are you 18 years or older?

Yes

Please state your age

Phone Number

Are you legally permitted to work in the United States?

Yes

Proof of lawful employment eligibility in the United States will be required upon employment in accordance with the Immigration Reform and Control Act of 1986.

Employment Desired

Type of Position Interested In

Date You Can Start

Salary Desired

Are you employed now?

Yes

May we contact your current employer?

Yes

Have you ever applied to this town before?

Yes

When have you previously applied with us?

Have you ever worked for this town before?

Yes

When have you previously been employed with us?

How did you find out about this town?

Education

Name and Location of High School

No. of years attended

Did you graduate from high school?

Yes

Subjects Studied

Name and Location of College/University

No. of years attended

Did you graduate from college/university?

Yes

Subjects Studied

Name and Location of Graduate School

No. of years attended

Did you graduate from Graduate school?

Yes

Subjects Studied

Name and Location of Trade or Business School

No. of years attended

Did you graduate from Trade or Business school?

Yes

Subjects Studied

General

Special Training or Skills Useful to Position Sought

Do you have a professional or trade license?

Yes

If yes, please explain.

Do you have a drivers license?

Yes

Former Employers

List below last three employers, starting with your most recent employer first.

Name and Address of Employer

Dates of Employment

Job Title

May we contact supervisor?

Yes

Name and Title of Supervisor

Supervisor Phone Number

Description of Work

Reason for Leaving

Name and Address of Employer

Dates of Employment

Job Title

May we contact supervisor?

Yes

Name and Title of Supervisor

Supervisor Phone Number

Description of Work

Reason for Leaving

Name and Address of Employer

Dates of Employment

Job Title

May we contact supervisor?

Yes

Name and Title of Supervisor

Supervisor Phone Number

Description of Work

Reason for Leaving

References

Name

Reference Address

Business

Years Acquainted

Name

Reference Address

Business

Years Acquainted

Name

Reference Address

Business

Years Acquainted

Attach Resume (optional)

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Certification and Authorization

"I certify that the facts and responses set forth in this application, or otherwise made by me, are true and complete to the best of my knowledge and belief. I authorize the investigation of all statements contained in this application or otherwise made by me, as may be necessary in arriving at an employment decision. I understand that any false statements made by me in this application, or otherwise, constitute sufficient cause for rejection of this application or, if employed, grounds for dismissal. I also understand that this application for employment is not a contract and is not intended to confer or create contractual rights of any kind or nature. No representations have been made to me by the Employer and I have no relied upon any representations by the Employer."

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.