Employment Application s15
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New Milford Public Library 24 Main Street New Milford, CT 06776 Mark P. Hasskarl, Director
Employment Application The TOWN OF NEW MILFORD considers all applicants for employment without regard to race, color, religion, sex, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law. In addition, The Town complies with applicable state and local laws prohibiting discrimination in employment in every jurisdiction in which it maintains facilities. The Town also provides “reasonable accommodations” to qualified individuals with disabilities, in accordance with the Americans with Disabilities Act and applicable state and local laws.
Applicant Information
Full Name: Date: Last First M.I.
Address: Street Address Apartment/Unit #
City State ZIP Code
Phone: Email
Date Available: Social Security No.: Desired Salary:$
Position Applied for:
YES NO YES NO Are you a citizen of the United States? If no, are you authorized to work in the U.S.?
YES NO Have you ever been employed by us? If yes, when?
YES NO Have you ever been convicted of a felony?
If yes, explain:
Education
High School: Address:
YES NO From: To: Did you graduate? Diploma::
College: Address:
YES NO From: To: Did you graduate? Degree:
Other: Address: YES NO From: To: Did you graduate? Degree:
Personal References Please list three personal references, excluding relatives.
Full Name: Relationship: Address: Phone:
Full Name: Relationship: Address: Phone:
Full Name: Relationship: Address: Phone: ____
Previous Employment
Company: Phone: Address: Supervisor:
Job Title: Starting Salary:$ Ending Salary:$
Responsibilities:
From: To: Reason for Leaving:
YES NO May we contact your previous supervisor for a reference?
Company: Phone: Address: Supervisor:
Job Title: Starting Salary:$ Ending Salary:$
Responsibilities:
From: To: Reason for Leaving:
YES NO May we contact your previous supervisor for a reference? Company: Phone: Address: Supervisor:
Job Title: Starting Salary:$ Ending Salary:$
Responsibilities:
From: To: Reason for Leaving:
YES NO May we contact your previous supervisor for a reference?
Job-related Skills
Disclaimer and Signature I 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: