EMPLOYMENT APPLICATION
Applications are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or in the presence of a non-related medical condition or handicap.

Contact Information
First Name:
Last Name:
Address 1:
City:
State:
Postal Code:
How should we contact you ?
Phone Number::
Cell Phone::
Email Address:
Information Requested
Are you a citizen of the United States of America?
Have you applied here before?
Position applied for?
Position you are applying for
Date Available
Schedule
(select all that apply)
 Full time  Part time  Temporary
Hours Desired
How did you hear about job opening?

EMPLOYMENT EXPERIENCE
Start with your present job or last job. Include military assignments and other volunteer activities. Exclude organizational names which indicate race, color, religion, sex, or national origin.
Employer 1
Address
City
State
Phone Number
Supervisor Name
Job Title
Reason for leaving
Describe duties
 
Dates of Employment

Salary or Hourly rate
Employer 2
Address
City
State
Phone Number
Supervisor Name
Job Title
Reason for leaving
Describe duties
 
Dates of Employment
Salary or Hourly rate
Employer 3
Address
City
State
Phone Number
Supervisor Name
Job Title
Reason for leaving
Describe duties
 
Dates of Employment
Salary or Hourly rate
EDUCATION
Schools/Colleges Attended:
School Name
# Years
Year Grad.
Degree
School Name
# Years
Year Grad.
Degree
School Name
# Years
Year Grad.
Degree
Describe any special qualifications for this job and what interests you about working at Nashawtuc:
 
 


I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or interview may result in termination. If hired, I have the freedom to quit at any time. The employer also has the right to terminate my employment with or without cause, the exceptions being as required by law. After termination of employment, for whatever reason, I release the above employer from liability for any information supplied to future potential employers.
Signature
Date

  

* Bold Fields are Required