Employment Application

First Name

Middle Name

Last Name

Social Security Number

Street Address

City

State

ZIP

Phone

Email Address

If hired, can you provide evidence of legal eligibility to work in the US?YesNo

Any offer of employment is conditioned upon completing form I-9 and providing the appropriate documents for identity and work authorization.

Position desired

Wages/salary desired

Type of Position

Do you carry a valid drivers license?YesNo

If no, please explain

Have you ever been convicted of a felony, or a misdemeanor?YesNo

If yes, please explain

Date of Birth

Name of high school attended

City

State

Degree

Name of college or technical school

City

State

Degree

Major

Are you presently enrolled in school?YesNo

If yes, give name and address of school and expected degree date

List any job-related skills or accomplishments, including military service

Monday

Your Availability For Work

Monday

From

Tuesday

From

Wednesday

From

Thursday

From

Friday

From

Saturday

From

Sunday

From

Total hours per week you are available to work

Do you have any special requests or needs for a work schedule

References

Give three references (that are not relatives) who we may contact

Name

Company & Relationship

Phone

Name

Company & Relationship

Phone

Name

Company & Relationship

Phone

Your Employment History

List names of employers with present or last employers listed first. Please note if we may contact your present employer until after your are offered a position.

Name of Employer

Street Address

City

State

ZIP

Supervisor

Phone

May we contact?YesNo

Job Title

Duties

Dates of Employment

From

Hourly pay or salary

Starting pay

Ending pay

Reason for leaving

Name of employer

Street Address

City

State

ZIP

Supervisor

Phone

May we contact?YesNo

Job Title

Duties

Dates of Employment

From

Hourly pay or salary

Starting Pay

Ending Pay

Reason for leaving

Name of Employer

Street Address

City

State

ZIP

Supervisor

Phone

May we contact?YesNo

Job Title

Duties

Dates of Employment

From

Hourly pay or salary

Starting pay

Ending pay

Reason for leaving

CAREFULLY READ EACH STATEMENT BEFORE SIGNING AT THE BOTTOM

I certify that all of the information provided in the employment application I true an complete to the best of my knowledge, and I authorize investigation of all statements contained in this application, including a criminal background check. I understand that any false or incomplete information may disqualify me from further consideration for employment and may result in my immediate discharge if discovered at a later date.

I understand and acknowledge that unless otherwise defined by applicable law or written agreement with Town of Morgantown, any employment relationship with the Town of Morgantown is considered "employment at will." This means the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause, and without advance notice.

I authorize the investigation of any or all statements contained in this application and also authorise any person, school, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I have read, understand, and agree to the above statements.

Signature

Date