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2. APPLICATION FOR EMPLOYMENT
4. Available Date for Work
6. Position you are applying for
7. Part-Time or Full-Time
8. Seasonal?
10. Name: Last, First, Middle I.
12. Telephone Number
13. Email Address
15. Street Address, City, State, Zip
16. Are you at least 18 years of age?
18. How did you learn about this position? (website, newspaper, or referral)
19. Name of who referred you
21. Have you previously worked for the Town?
22. If yes, list the dates & positions held
24. Education
26. High School Name & Location
27. Did you graduate?
29. Trade School & Location
30. Did you graduate?
32. College & Location
33. Did you graduate?
35. Additional Education
37. COMPUTER SKILLS AND WORK-RELATED CERTIFICATIONS
39. Indicate your proficiency level below using 1 to 5 with "5" being "Expert."
41. Microsoft Word
42. Microsoft Excel
43. Microsoft Outlook: Email/Calendar
45. MUNIS Payroll/Accounting
46. PDF Adobe
47. Quick Books
49. Other Software
51. EMPLOYMENT HISTORY & BUSINESS EXPERIENCE
53. Please list below employers in consecutive order with present or most recent employer list first. A resume may be attached but DO NOT refer to the resume when completing all sections of this application. Applicants may include military service or any verified work performed on a volunteer basis. You may exclude the names of organizations which indicate race, color, religion, gender, national origin, disability, or other protected class.
55. May we contact your current employer?

    1. Yes

    1. No
57. Current Employer
58. Start Date
59. End Date
61. Full Address
62. Job Title
64. Supervisor's Name
65. Super's Phone #
67. Describe the work you perform
69. Reason for Leaving
73. Former Employer
74. Start Date
75. End Date
77. Full Address
78. Job Title
80. Supervisor's Name
81. Super's Phone #
83. Describe the work you performed
85. Reason for Leaving
89. Former Employer
90. Start Date
91. End Date
93. Full Address
94. Job Title
96. Supervisor's Name
97. Super's Phone #
99. Describe the work you performed
101. Reason for Leaving
103. REFERENCES
105. Name
106. Address
107. Telephone Number
108. Relationship to you
110. Name
111. Address
112. Telephone Number
113. Relationship to you
115. Name
116. Address
117. Telephone Number
118. Relationship to you
120. Some positions require a Driver's License. Do you have a valid Driver's License?
122. APPLICANT'S CERTIFICATION, RELEASE AND SIGNATURE
124. Thank you for completing the employment application. Please read the following carefully and sign the below indicating your understanding and agreement. If you have any questions regarding the following statements, please contact Human Resources at (781) 279-2620
126. Please read carefully and check-off box to signify you have read and understand the following statements:
129. I understand that any offer of employment that I receive from the Town of Stoneham is contingent upon my successful completion of the pre-employment screening processincluding but not limited to the Town of Stoneham recievving satisfactory references, a satisfactory criminal history and Criminal Offense Record Inquiry ("CORI check"), and a post-offer pre-employment drug test, physical examination, or psychological screening. I understand that I must provide proof of citizenship or immigration status within three days of my hire date.
132. The information that I have provided is true and complete. I understand that misrepresentation or omission of any relevant fact im my application, resume or in any other materials or as provided during interviews, can be justification for refusal of employment or can be justification for termination from employment, if I am employed.
135. I understand that the Town of Stoneham may verify all of the information provided by me concerning, among other things, my prior employment or military record, education, character, general reputation and personal characteristics.
138. I authorize the Town of Stoneham to take whatever steps deemed necessary to obtain information regarding my qualifications for employment including contacting individuals listed as business, educational or personal references, and by contacting other individuals to provide or further clarify information about me.
141. I hereby release all of those persons, employers, references, acedemic institutions and law enforcement agencies from any and all liability arising from their giving and recieving information about my employment history, academic credentials, qualifications or criminal record in connection with my application for employment in the Town of Stoneham.
144. If I am employed by the Town of Stoneham, I understand that as a condition of continued employment I may be required to furnish additional or updated medical information, that I may be required to undergo a physical or psychological examination, that I may be subject to drug and/or alcohol testing, that the Town of Stoneham may request a CORI and SORI check on me, investigate my driving record or verify my license(s) or certification(s) as required for employment at any time during my employment.
147. I understand that nothing in this employment application, in the Town's statements of personnel policies or guidlines or in my communication with any Town employee or official is intended to create an employment contract between myself and the Town other than an applicable collective bargaining agreement.
150. I understand that the Town of Stoneham is an at-will employer, which means that if employed, my employment may be terminated with or without cause at any time unless there is an applicable bargaining unit contract provision.
152. My signature below certifies that I have read and agree with all statements contained in this application for employement.
154. Applicant's Signature
155. Date Signed
Leave This Blank:


157. 1. Receive an email copy of this form.
158. Email address

     This field is not part of the form submission.

159. Submit Submit and Print

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