HomeMy Public PortalAboutApplication For Employment 2023APPLICATION FOR EMPLOYMENT ,
(PRE -EMPLOYMENT QUESTIONNAIRE) (AN EQUAL OPPORTUNITY EMPLOYER)
PERSONAL INFORM/MOH .
DATE
SOCIAL SECURITY
NAME NUMBER
ST FIRS ODE
PRESENT ADDRESS T p
STR ET
PERMANENT ADDRESS
STR
PHONE NO. ARE YOU 18 YEARS OR OLDER? Yes 0 No 0 _ _._ - - . _._..... . ....,.,
ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED
OF VISA OR IMMIGRATION STATUS? Yes I-3 No El
IN THIS COUNTRY BECAUSE
EMPLOYMENT D E:SI REI --- �
DATE YOU SALARY
CAN START DESIRED
POSITION -
REFERRED BY
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NAME AN. LOCATION OF SCHOOL
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85J OF- SP- S-VAL STUDY OR RESEARCH, inRX
SPECIAL SKILLS
ACTIVITIES: CHIC AiHLET1C ETC,
EXCLUDE ORGANIZATIONS; THE NAME OF WHICH INDICATE THE RACE, CREED, SEX, AGE, MARITAL STATUS. COLOR OR NATION OF ORIGIN OF ITS MEMBERS
U.S. MILITARY OR
NAVAL SERVICE
RANK
PRESENT MEMBERSHIP IN
NATIONAL GUARD OR RESERVES
(CONTINUED ON OTHER SIDE)
POWER EMFLOYERS LIT F sU< M 71-1/1SE I!!VIZYESiS, STAKINO wi1Th THE. L r Jt pi -m,
DATE
MONTH AND YEAR
FROM
TO
FROM
TO
FROM
TO
FROM
TO
NAME AND ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
WHICH OF THESE JOBS DID YOU LIKE BEST?
WHAT DID YOU LIKE MOST ABOUT THIS J013?
PEF ENI ES!I ONE "flig NAMES OI~`"I HREn PERSONS NOIREII.6TEDTO you. V M you HAVE i4N tWI4.A,TL EAST SARI
YEARS
ACQUAINTED
NAME
ADDRESS
BUSINESS
1.
2.
3.
THE FOLLOWING STATEMENT APPLIES IN; MARYLAND & MASSACHUSETTS (NAME OF STATE)
IT IS UNLAWFUL IN THE STATE OF TO REQUIRE OR ADMINISTER A LIE DETECTOR TESTAS A
CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO
CRIMINAL PENALTIES AND CIVIL LIABILITY.
IN CASE OF
ME80EN.C_Y_NOTLFY..._ _... .. _._ ..__ ...._. .... _.. _--r .................... ----..._...,_._.___- _. __.__..�---•--._-...------.-._
NAME - ADDRESS PHONE NO.
"I CERTIFY THATALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND UNDERSTAND THAT IFANY
. FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF IA141 EMPLOYED,
MY EMPLOYMENT MAY BE TERMINATED ATANY TIME.
IN CONSIDERATION OF MY EMPLOYMENT, (AGREE TO CONFORM To THE CARTERETADMINISTRATION'S RULES AND REGULATIONS, AND 1
AGREE THAT MY EMPLOYMENTAND COMPENSATION CAN BE TERMINATED WITH OR WITHOUT CASE, AND WITH OR WITHOUT NOTICE; AT ANY
T1ME, AT EITHER MY OR THE COMPANY'S OPTION, I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT
MAYBE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE,ATANYTIME BY THE COMPANY, I UNDERSTAND THAT NO
COMPANY REPRESENTATIVE, OTHER THAN THE MAYOR, AND THAN ONLY WHEN IN WRITING AND SIGNED BY THE MAYOR, HAS ANYAUTHORITY
TO ENTER INTO AN AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE
FOREGOING.
gnature o pp icant
RATE__ — SfGNAZU E _ — —
DO NOT WRRTE BELOW THIS LINE
INTERVIEWED BY
DATE
RI=M AR —ICS
NEATNESS . _ ABILITY_�__�___�
HIRED: 0 Yes 0 No
SAL�,RYI WAGE
POSITION
T m DEPT..
DATE .iEPQRTI G TO WOR..
AZERLDVED:_ 2
MAYOR
DEPT, HEAD
This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination.