Applicant Information

Today's Date*

First Name*

Middle Initial *

Last Name*

Street Address*

City*

State

Zip*

Phone*

Email Address*

Position You're Applying For*

Where did you learn about this position?*

Are you eligible to work in the United States? *

Yes

No

Have you ever worked for the City of Winooski? *

Yes

No

If yes, when? (MM/DD/YY - MM/DD/YY)*

Does this position require a CDL? *

Yes

No

Do you have any relatives that work for this municipality? *

Yes

No

If yes, who?*

Education

High School

Name of School*

Address*

Number of Years Attended*

Did you Graduate?*

Yes

No

College

Name of School*

Address*

Number of Years Attended*

Did you Graduate?*

Yes

No

Other

Name of School*

Address*

Number of Years Attended*

Did you Graduate?*

Yes

No

Employment

Current Employer

Name of Employer*

Dates of Employment (MM/DD/YY - MM/DD/YY)*

Responsibilities *

Reason For Leaving*

Name of Supervisor *

May we contact this employer and supervisor for a reference? *

Yes

No

Previous Employers

Name of Employer*

Dates of Employment (MM/DD/YY - MM/DD/YY)*

Responsibilities *

Reason For Leaving*

Name of Supervisor *

May we contact this employer and supervisor for a reference? *

Yes

No

Name of Employer*

Dates of Employment (MM/DD/YY - MM/DD/YY)*

Responsibilities *

Reason For Leaving*

Name of Supervisor *

May we contact this employer and supervisor for a reference? *

Yes

No

Professional Reference 1

Full Name *

Company*

Address*

Phone*

Relationship*

Professional Reference 2

Full Name *

Company*

Address*

Phone*

Relationship*

Professional Reference 3

Full Name *

Company*

Address*

Phone*

Relationship*

Additional Information

Please list any other relevant certifications, skills, education, training or licenses you possess:*

Military Service

Branch*

Dates of Service (MM/DD/YY - MM/DD/YY)*

Rank at Discharge *

Military Experience Relevant to Position Applied For:*

Non-Discrimination Statement

It is the policy of this Municipality to provide equal opportunity to apply to all applicants and employees without regard to race, color, religion, sex, national origin, ancestry, place of birth, age, marital status, pregnancy status, genetic information, physical or mental condition, HIV status, veteran status, sexual orientation, gender identity, or other category protected by state or federal law. No question is asked on this application or during the application process for the for the purpose of excluding any applicant due to the aforementioned protected categories or other category protected by law.

Disclaimer and Signature

Type Name*

Today's Date (MM/DD/YY)*

By clicking yes, I hereby attest that all information provided by me is true and correct to the best of my knowledge. I understand omissions or misrepresentations may be cause for rejection or, if employed, may be cause for immediate dismissal. I hereby authorize any former employer, person, firm, corporation or educational institution listed heron including this municipality to answer any and all questions, provide documents and agree to hold all persons harmless for giving any and all truthful information within their knowledge or records. I understand this is a preliminary application and not a contract for employment. Furthermore, in the event I am hired, my employment shall be completely voluntary and may be terminated at will at any time for any non-discriminatory reason upon notice by either myself or the municipality. I agree to comply with all reasonable rules of the municipality and condition of employment.

Check*

Yes

Please upload a copy of your resumé. *

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