Employment Application
The TOWN OF
DOVER MA is an Aflirma6ve Action
Equal Opportunity Employer and does not discriminate on the
color religion national origin ancestry sex sexual orientation physical or mental disability marital or
veteran status age or other protected status
basis of race
PLEASE ANSWER ALL OF THE QUESTIONS ON THE FOLLOWING PAGES ACCURATELY AND
COMPLETELY
IF YOU NEED ASSISTANCE COMPLETING THIS APPLICATION ASSISTANCE WILL BE
PROVIDED
Date
Name
Last
First
street
cay
state
z
code
sweet
cay
state
zip
code
Zip Code
From
To
Zip Code
From
To
Present Address
Permanent Address
Previous Addresses within the
Home
past
5 years if different
sorest
City
state
Street
City
State
Telephone
Number
Other
Area Code
Social
Security
telephone number
s
Number
where you can be reached
1
L
Area code
Are you authorized to work in the United States
Note All
Yes
1
Arm Code
No
hired
applicants
by the Town of Dover will be required to present documentation prior to s
arting work with the Town of Dover that
verifies identity and authoriza
ion to work in the United States in accordance with the Immigration Reform and Control Act of 1986
Position Desired
Salary Desired
Please check whether you are seeking
If you have a relative
s who
currently
Full Time
Part Time
Days
Weekends
Summer
Nights
works for the Town of Dover
If you have everworked for the Town of Dover
please
Date Available
answer
the
please
indicate name
Only
position
and location
following
Dates
nUBrarx3r
Deparlrr
If you have ever applied for a
Where
Location
position with the
Position
Town of Dover
Start Data
please
answer
the
Date
following
End Date
II Education
Name and Address of School
Course
of
High
Study
Dates
Attended
Did You
Graduate
School
Degree
Specify
Yes
No
College
Yes
No
Other licenses
certificates etc
Yes
p
specify
Record ALL work
No
or military duty You may indude any work
experience inducting jobs held while attending school and
performed
provide all relevant information requested in this section even if you are attaching a resume as part of this
volunteer basis Please
application
LIST MOST RECENT JOB FIRST
1 Employer
Date Employed
From
Address
Job Title
Supervisor
State major
responsibilities
or
duties
Salary
Reason for
2 Employer
leaving
Date Employed
From
Address
to
Telephone Number
Job Title
State
to
Telephone Number
I
Supervisor
major responsibilities
or
duties
Salary
Reason for leaving
3
Employer
Date Employed
From
Address
Telephone Number
Job Title
Supervisor
State
major responsibilities
or
duties
to
Salary
Reason for
4 Employer
leaving
Date Employed
From
to
Address
Telephone Number
Job Title
Supervisor
State
major responsibilities
or
duties
Salary
Reason for
May we contact
Was your
If yes
your present
employment
ever
employer
terminated
Yes
involuntarily
or were
leaving
No
you
ever
asked to
resign
Yes
No
please explain
If in any of the
positions
or
schools your last name was different from the one you are now
using please
indicate
s date
name
s
on
a
ecializer
FOR CLERICAL APPLICANTS ONLY
Please check those skills that you have and the
types
of office
equipment
that you can use
competently
SKILLS
HARDWARE
Typing
SOFTWARE
wpm
error
rate
Word
Processing
Software
System
Data
Entry
It is unlawful in Massachusetts to
employer who
Before
answering
An
require or administer a lie detector test as a condition
subject to criminal penalties and dvil liabilities
of
employment
or
continued
employment
An
violates this law shall be
the
following questions please
read
carefully the paragraphs printed
below
for
applicant
employment with a sealed record on file with the Commissioner of Probation may answer no record with respect to an
inquiry herein relative to prior arrests criminal court appearances or convictions In addition any applignt for employment may answer no
record with respect to any inquiry relative to prior arrests court appearances and
adjudications in all cases of delinquency or as a child in
need of services that did not result in a complaint transferred to the Superior Court for criminal prosecution
Have you ever been convicted of a felony
If yes
Yes
No
please explain
Have you ever been convicted of a misdemeanor Do not indude a prior first
conviction for drunkenness simple assault speeding minor
traffic violations affray or disturbance of the peace or a conviction for any misdemeanor where the conviction occurred or
any prison sen
tence ended five or more years ago whichever date is later unless you have been convicted of another offense within the last five
years
Yes
If yes
No
please explain
We may conduct an investigation regarding your character employment education credit and criminal
history prior to extending an offer of
employment and at any time during your employment Should we deny or terminate your employment wholly or in part on the basis of
information contained in a consumer report supplied to us by a consumer reporting agency we will
supply to you the name and address of
that agency
s
nnlicant
atinn anc Ac
CPrtifir
I understand that this
application
I understand that if I am hired
is currentfor 60
days
If 1 still wish to be considered at the end of this
period
I must fill out a new
applicafion
the Town of Dover I will be an
by
will that I will be free to resign at any time and that the Town of
employee at
Dover reserves the right to terminate the employment at any time with or without cause regardless of the date of payment of mywages and
salary I understand that if I am hired I will be required to abide by the rules and regulations of the Town of Dover
The information I have
statement
or
significant
supplied
in this
omission
by
application or as a part of the application process is true and complete I understand that any false
the application or application process may be cause for dismissal rf discovered at a later date
me in
I
hereby authorize the Town of Dover to investigate the information I have furnished on this application and
subject to acceptable educational references employment references and other references as applicable
Date
Signature
Affirmative Action
Equal Opportunity Employer
I understand that
employment
is