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Personal Information

First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
May we contact you via email?*
1. Yes
1. No
Are you 18 years of age or older?*
1. Yes
1. No
Are you eligible to work in the United States?*
1. Yes
1. No
Upon hire you will be required to provide proof of eligibility.
Have you previously been employed by the City of Milford?*
1. Yes
1. No
If yes, what position?
Dates:
Dates: Start Date
—
Dates: End Date
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Which position are you applying for?*
Type of employment desired:*
1. Full Time
1. Part Time
1. Temporary
1. Internship
When are you able to begin employment?*
When are you able to begin employment?
Are any of your relatives employed with the City of Milford?*
1. Yes
1. No
If yes, what is their name?
Relationship?
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Highest level of compulsary education completed:*
High School
Address
Highest level of higher education completed:
College/University/Trade School
Address
Degree/Diploma
Highest level of postgraduate education completed:
Postgraduate School
Address
Degree
Special training or skills of benefit to the position which you are applying:
For example: second language, machine operation, etc.
Do you possess a valid Driver's License?*
1. Yes
1. No
If yes, which class?
If you possess a Commercial Driver's License, what date does your Medical Examiner's Certificate expire?
If you possess a Commercial Driver's License, what date does your Medical Examiner's Certificate expire?
Has your Driver's License ever been suspended due to operating a vehicle under the influence of drugs or alcohol?*
1. Yes
1. No
Have you served in the U.S. Armed Forces?*
1. Yes
1. No
If yes, which branch?
Final Rank:
Reserve Status:
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I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*
Date*
Date

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