HomeMy Public PortalAboutTown of Brewster Employment Application
Town of Brewster Employment Application
2198 2198 Main Street Brewster, MA 02631 | Phone: 508-896-3701 | Fax: 508-896-8089 | www.brewster-ma.gov
An Equal Opportunity Employer
The Town of Brewster is an equal opportunity employer and does not discriminate against any applicant because of race, color, religion,
sex, marital status, national origin, age, disability, sexual orientation, gender identification, gender expression, genetic information or
any other class protected by federal, state or local law. Any person who needs assistance in fully participating in the application process
should contact the office of the Town Administrator.
A fully completed application is required for each position applied for. Also, “see resume” is not acceptable in any field.
CONTACT INFORMATION:
Last Name First M.I. Date:
Address
Home Phone Cell Phone Email
Position Applying For Date Available How Did You Hear About This Position
Are You Seeking _______ Full Time _______ Part Time _______ Temporary Employment?
Are You Under The Age of 18? ________ If Yes, Please Indicate Your Age ________ The Town of Brewster is subject to certain child
labor provisions regarding the employment of persons under the age of 18. Please Note: If you are a minor, under the age of 18, you
may be required to produce a current work permit.
EDUCATION:
Graduated?
High School/GED Address Number of Years Attended
College Address Number of Years Attended Degree
Graduate School Address Number of Years Attended Degree
Trade, Business, Night Courses, Certificates
Military Service or Other Special Training
LICENSES:
Do You Have a Valid Driver’s License (Class D Auto) Yes____ No____ Expiration Date__________________________________
Do You Have a Valid Class A or B CDL Yes____ No____ Expiration Date__________________________________
Do You Have a Valid Hydraulic License Yes____ No____ Expiration Date__________________________________
Do You Have Any Other Job Related Licenses or Certifications _______________________________________________________________________
SKILLS Beginner Intermediate Level Advanced Level
Knowledge of Word Processing
Knowledge of Spreadsheets
Knowledge of Databases
Automated Accounting System Knowledge
PREVIOUS EMPLOYMENT – Please do not write “see resume”
Start with your present or last employer. You may include military service & any verifiable work performed as an intern of volunteer.
We may_____ may not_____ contact your present employer.
Employer Address
Telephone Your Title
Supervisor Supervisor’s Title
Dates Worked Reason for Leaving
Description of Primary duties:
Description of Primary duties:
Description of Primary duties:
Business References That We May Contact, A Minimum of 3 References are Required
Employer Address
Telephone Your Title
Supervisor Supervisor’s Title
Dates Worked Reason for Leaving
Employer Address
Telephone Your Title
Supervisor Supervisor’s Title
Dates Worked Reason for Leaving
Name Address Phone Relationship
Medical Information
All offers of employment are conditional upon a physical examination, and an occupational evaluation, where required.
Satisfactory fitness to perform the essential duties of the position, with or without a reasonable accommodation is a
condition of employment.
Pre-Employment Drug Test
All offers of employment are conditional upon the satisfactory completion of a pre -employment drug test, where required.
Satisfactory completion of a required drug or alcohol test is a condition of employment as outlined in the Drug and
Alcohol Testing Policy of the Town of Brewster.
Lie Detector Test
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued
employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Signature
CAREFULLY READ ALL PARTS OF THIS APPLICATION FORM BEFORE SIGNING.
A. I understand that acceptance of this application by the Town of Brewster does not imply that I will be employed.
B. The information that I have provided is true and complete. I understand that misrepresentation or omission of
any fact in my application, resume, or in any other materials, or as provided during interviews, may be
justification for the refusal of employment or may be justification for termination from employment, if employed
whenever the information is discovered.
C. I understand that any offer of employment that I receive from the Town of Brewster is contingent upon my
successful completion of the pre-employment screen process including but not limited to the Town of Brewster
receiving satisfactory references, a satisfactory criminal history and Criminal Offense Record Inquiry, satisfactory
verification of driver’s license or certifications where required and satisfactory completion of any required post -
offer pre-employment drug test or physical examination.
D. In processing my application for employment, the Town of Brewster may verify all of the information provided by
me concerning, among other things, my prior employment, volunteer work or military record, education,
character, general reputation and personal characteristics, and may review any social media accounts.
E. I authorize the Town to take whatever steps deemed necessary to obtain information regarding my qualifications
for employment including contacting my present and former employers, by contacting individuals listed as
business, educational or personal references, and by contacting other individuals to provide or further clarify
information about me and I release the Town and its employees and agents from any liability resulting from the
verification process.
F. I hereby release my present and former employers and all individuals contracted for factual information about me
from any and all liability for damages arising from furnishing the requested information.
G. If employed by the Town of Brewster, I understand that as a condition of employment, I may be required to
furnish additional or updated medical information, that I may be required to undergo a physical examination,
and/or an occupational evaluation, that I may be subject to drug and/or alcohol testing, that the Town may
request a Criminal Offense Record Inquiry (CORI check) on me, investigate my driving record or verify my
license(s) or certifications(s) as required for employment at any time during my employment. As a condition of
employment an employee may be required to provide additional or updated info rmation and may require both
drug testing and an employment physical in order to allow us to the have the necessary information for making a
proper decision on reasonable accommodations, if necessary.
H. I understand that the Town of Brewster is an at-will employer. I understand that my employment may be
terminated with or without cause at any time unless I am subject to the terms of a collective bargaining
agreement and I have completed the required probationary period.
My signature Certifies that I have read and agree with the above statement and all statements contained in this
application for employment.
Applicant Name (Please Print)
Applicant Signature Date