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Employment Application
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Steps
1.
Personal Information
This section is complete
This section is incomplete
2.
Position Information
This section is complete
This section is incomplete
3.
Education, Skills, Qualifications and Experience
This section is complete
This section is incomplete
4.
Employment History
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5.
References
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6.
Equal Employment Opportunity Survey
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7.
Disclaimer & Signature
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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?
*
Yes
No
Are you 18 years of age or older?
*
Yes
No
Are you eligible to work in the United States?
*
Yes
No
Upon hire you will be required to provide proof of eligibility.
Have you previously been employed by the City of Milford?
*
Yes
No
If yes, what position?
Dates:
Dates: Start Date
—
Dates: End Date
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Position Information
Which position are you applying for?
*
Type of employment desired:
*
Full Time
Part Time
Temporary
Internship
When are you able to begin employment?
*
When are you able to begin employment?
Are any of your relatives on City Council or employed with the City of Milford?
*
Yes
No
If yes, what is their name?
Relationship?
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Education, Skills, Qualifications and Experience
Highest level of compulsary education completed:
*
-- Select One --
1
2
3
4
5
6
7
8
9
10
11
12
High School
Address
Highest level of higher education completed:
-- Select One --
1
2
3
4
College/University/Trade School
Address
Degree/Diploma
Highest level of postgraduate education completed:
-- Select One --
1
2
3
4
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?
*
Yes
No
If yes, which class?
-- Select One --
CDL
Class A
Class B
Class C
Class D
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?
*
Yes
No
Have you served in the U.S. Armed Forces?
*
Yes
No
If yes, which branch?
-- Select One --
Army
Navy
Marine Corps
Air Force
Coast Guard
Final Rank:
Reserve Status:
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Employment History
(From Most Recent)
Company
Position
Supervisor
Phone Number
Address
Responsibilities
Employed From - To
Employed From - To Start Date
—
Employed From - To End Date
Reason for Leaving
May we contact your most recent employer for a reference?
Yes
No
Company
Position
Supervisor
Phone Number
Address
Responsibilities
Employed From - To
Employed From - To Start Date
—
Employed From - To End Date
Reason for Leaving
Company
Position
Supervisor
Phone Number
Address
Responsibilities
Employed From - To
Employed From - To Start Date
—
Employed From - To End Date
Reason for Leaving
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References
Please list three professional references.
Full Name
*
Company
*
Position
*
Phone Number
*
Full Name
*
Company
*
Position
*
Phone Number
*
Full Name
*
Company
*
Position
*
Phone Number
*
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Equal Employment Opportunity Survey
Instructions
This EEO Survey will be detached from the application and kept separately. It will not be used as a basis for making employment decisions. To help the City of Milford meet its Equal Employment Opportunity goals and objectives, and in order to comply with various government requirements, please mark the appropriate identification categories below. The survey describes identification categories in detail. Providing this information is voluntary and your application will not be adversely affected if you respond or decline to respond. This information will be used only in accordance with federal laws and regulations.
Last Name
First Name
Middle Name
Date of Birth
Position Applied For
Sex
Male
Female
Other
Referral Source
Community Agency
State Agency
Private Employment Agency
Newspaper
Job Fair
City Website
City Employee
Other
Race
American Indian/Alaskan Native
Asian
Black/African American
Native Hawaiian/Pacific Islander
White
Ethnicity
Hispanic/Latino
Not Hispanic/Latino
Definitions
American Indian/Alaskan Native: A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black/African American: A person having origins in any of the Black racial groups of Africa.
Native Hawaiian/Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Hispanic/Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
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Disclaimer & Signature
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
*
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