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Employment Form

Employment Formadmin2022-06-21T11:12:17-05:00

"*" indicates required fields

Name*

Acceptance

IMPORTANT - Please read before completing application form
Consent
I certify that all of the statements made in this Application Form are true, complete and correct to the best of my knowledge. I understand that false or misleading statements may be sufficient ground for not being hired, or upon discovery once hired, grounds for discharge. I authorize the Town of New Carlisle (or their designee) to contact previous employers, references, schools and others deemed necessary in order to obtain additional information and to verify the information contained in this Application and accompanying resume (if any). I release the Town and any respondent from any liability for information released.

The Town of New Carlisle’s policies includes adherence to the Drug-Free Work Place Act of 1988. I understand and agree that employment may be contingent upon passing a drug and /or alcohol test.

I understand that in consideration of my employment, I agree to follow the policies and procedures of the Town. I further understand that employment may be terminated by me and/or the Town with or without cause or notice and that this Application Form does not constitute an employment agreement for any specific period of time.

Federal law requires documents to prove identity and legal authorization to work in the United States. I understand that I will be asked to show necessary proof (such as a birth certificate, a state issued driver’s license, United State Passport, unexpired INS employment authorization, etc.) within three days of being hired and that failure to show such documents is ground for employment termination.
Digital signature is your full name spelled out followed by the last 4 of your SSN.
Date
Hidden

Background Information

Address*
Previous Address
Are You Looking For
NOTE: Some positions require weekend, holiday and nights
NOTE: The Immigration and Control Act requires proof of your status.

Education and Military Experience

Work History

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 2

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 3

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 4

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 5

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 6

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 7

Please provide the last ten (10) years.
Address
Date From
Date To

Work History 8

Please provide the last ten (10) years.
Address
Date From
Date To
Address
Date From
Date To

Additional Information

Please complete the information relevant to the position(s) you are applying for.
Expiration Date

Personal References

List three (3) people you have worked for or with over the last three (3) years that we may contact for a reference. Please do not include supervisors listed in the Work History section.

Reference 1

Name
Address

Reference 2

Name
Address

Reference 3

Name
Address

New Carlisle

  • New Carlisle Town Hall
    124 E. Michigan St.
    New Carlisle, IN 46552

  • (574) 654-3733

  • Monday – Friday

    8:00 AM – 4:30 PM EST

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