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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 .. . E�rmui- UM4' { NAME AN. LOCATION OF SCHOOL 6N6 Or YEARS: i% YOU UM? SUBJECTS7 I31 ED ,G #MAR SCHOOL #H1;OH SCHOOL C mgaiteE 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.