Employment Application

Employment Application                                               We are an Equal Opportunity Employer

Please mail or bring your completed application to:

Town
  Townof of
         Durham
            Durham
  Town   Manager
Selectmen’s  Office
  630
630   Hallowell
    Hallowell    Road
              Road
  Durham,
Durham,      Maine
          Maine     04222
                 04222

 Job Data
Job Title:                                                     Date you will be available for employment:

Job Posting No:

 Personal Data
Last Name:                                        First Name:                                Middle:

Address:

City:                                              State:                             Zip:

Phone No.      Days:                               Evenings:                         Alternate:

All applicants who are offered employment must provide documents which establish their identity and employment
eligibility for authorization to work in the U.S. Do you have the legal right to work in the U.S.? Yes         No

Date of Birth (if less than 18):

Have you ever worked or volunteered for the Municipality?          Yes              No
If yes, please give dates:

Do you have any relatives employed with the Municipality?          Yes              No
If yes, please list:
Name                                  Division                               Relationship
Name                                  Division                               Relationship
Name                                  Division                               Relationship

Driver’s License No. and State:

Have you had any traffic convictions or accidents in the last three years?          Yes                No

If yes, please list:
Conviction or Accident                                                       Date
Conviction or Accident                                                       Date
Conviction or Accident                                                       Date

Commercial Driver’s License No. & State:              Class:                     Endorsements:      Expires:

Please list other names you have used:

Have you been convicted of any crime? Yes No If yes, please give details including dates, charts, and disposition. Convictions are not an absolute bar to employment. Consideration is given to the offense and its relationship to the position for which you are applying.

Education Note: Complete this application in its entirety, incomplete applications will not be accepted. Resumes may be attached, but will not be accepted in lieu of a completed application.

Did you graduate from High School or do you have a G.E.D.?                 High School Name:
               Yes                    No                                   Location:

Name of School, College(s) or University                   Major             Credit Hours           Degree*

*Proof of degrees from College/University obtained will be required upon hire.

Name of Trade/Technical/Business or Other
School(s) Attended                                                  Course of Study                 Diploma

List other licenses held (date & #), professional registrations (date), certificates and professional memberships:

List Honors, Awards, Fellowships:

Skills Overview Approximate Typing Speed in words per minute: List computer software with which you are familiar:

Fluent in a language other than English: Language(s):                       Speak:          Read:        Write:

Please summarize relevant skills and experience that exemplify your qualifications for the above position:

Tools and machines you can use and operate:

Light or heavy motor vehicle equipment you can operate:

Summarize Volunteer Services work including dates:

Summarize Leadership Roles:

Employment History Note: Complete this application in its entirety, incomplete applications will not be accepted. Resumes may be attached, but will not be accepted in lieu of a completed application.

Current or most recent employer:                                               Phone:

Address:

Your Title:

Employment Dates                     From:                                     To:

Supervisor’s Name/Title:

Starting Salary:                              Present/Ending:                        Hours per week:

Work Performed:

Reason for leaving:

May we contact this employer if you are considered for the position? Yes No

Employment History Note: Complete this application in its entirety, incomplete applications will not be accepted. Resumes may be attached, but will not be accepted in lieu of a completed application.

Employer:                                                                     Phone:

Address:

Your Title:

Employment Dates                   From:                                      To:

Supervisor’s Name/Title:

Starting Salary:                            Present/Ending:                         Hours per week:

Work Performed:

Reason for leaving:

May we contact this employer if you are considered for the position?    Yes                No

Employer:                                                                     Phone:

Address:

Your Title:

Employment Dates                    From:                                     To:

Supervisor’s Name/Title:

Starting Salary:                            Present/Ending:                         Hours per week:

Work Performed:

Reason for leaving:

May we contact this employer if you are considered for the position? Yes No

Employment History Note: Complete this application in its entirety, incomplete applications will not be accepted. Resumes may be attached, but will not be accepted in lieu of a completed application.

Employer:                                                                    Phone:

Address:

Your Title:

Employment Dates                   From:                                     To:

Supervisor’s Name/Title:

Starting Salary:                            Present/Ending:                        Hours per week:

Work Performed:

Reason for leaving:

May we contact this employer if you are considered for the position?   Yes                No

Employer:                                                                    Phone:

Address:

Your Title:

Employment Dates                   From:                                     To:

Supervisor’s Name/Title:

Starting Salary:                            Present/Ending:                        Hours per week:

Work Performed:

Reason for leaving:

May we contact this employer if you are considered for the position? Yes No

Military Service

Have you ever served on active duty in the U.S. Armed Forces?   Yes   No

Dates:            From:                                         To:

Branch:

Primary Duties:

Conditions of Consideration for Employment

All information contained on the application is subject to verification. The Municipality of Durham, Maine will conduct background checks including, but not limited to, work references, driving records, criminal background records and education attainment.

I understand an employment offer is also contingent upon successful review of work references, and satisfactory result of a background check. Certain positions are also conditioned on the successful completion of agility tests or skill evaluation and other appropriate investigations.

I also understand that specific positions at the Municipality of Durham, Maine may require me to provide evidence of an acceptable driving record.

I further understand that certain positions with the municipality may require the applicant to be eligible for bonding. In such instances, eligibility for bonding will be a consideration in determining an applicant’s fitness for such position.

If employed, I agree to abide by all municipal policies, regulations, ordinances and established work safety practices.

When advised, reasonable accommodations will be made in order for an “otherwise qualified applicant” with a disability to participate in any phase of the application/recruitment process. (Americans with Disabilities Act of 1991)

I certify that all the information provided herein is true and complete to the best of my knowledge. I agree and understand that omissions, misstatements, and falsifications will cause forfeiture on my part of all eligibility to any employment with the Municipality of Durham, Maine and may be cause for rejection of this application, removal of my name from eligibility lists, or discharge from municipal service.

In addition, I give the Municipality of Durham, Maine the right to investigate and verify any information obtained through the application process. Permission is granted and I release from any and all liability any employer, agency or individual assisting the Municipality of Durham, Maine in providing relevant, job related information that will assist in this process.

It is my understanding that this application along with any resume and letters/notes of reference, other than those letters and notes of reference I expressly submit in confidence, become a public document should I be hired by the municipality. As a result, I understand that the municipality can not guarantee me its confidentiality.

I have read and understand the above “Conditions of Consideration for Employment.”
        Yes           No     (Please acknowledge by circling the appropriate word.)

Print Name:                                                              Date:

Signature: