TOWN OF HOPKINTON, NEW HAMPSHIRE
Recreation Department
330 Main St. Hopkinton, N.H. 03229
Tel. (603) 746-2915
Fax (603) 746-2277
APPLICATION FOR EMPLOYMENT
The Town of Hopkinton does not discriminate in hiring on the basis of race, color, religion, sex, marital status, handicap or national origin. No question on this application is intended to secure information to be used for such discrimination.
Todays Date:__________
General Information
Name: _________________________________________________________________
Last First Middle
Present Address___________________________________________________________
Street Address Tel. No. (Home)
_________________________________________________________________________
City State Zip Code Tel. No. (Work)
Who should be contacted in case of emergency? ______________________________________
Military Record: __________________________________________________________________
Branch Date Occupation Type of Discharge
Actual Position applying for: ____________________________________________________
If applying for Camp Director position you must be 25 years of age or older.
If applying for a Lifeguard position you must be 17 years of age or older.
If applying for Senior Camp Counselor position you must be 18 years or older.
If applying for Junior Camp Counselor position you must be 16 years or older.
Hours available:___________________________ Date you may begin:_________________
List any elected or appointed position you may presently hold in the Town of Hopkinton:
List any relative working for the Town of Hopkinton:
Were you previously employed by us?_____________ If yes, when? _____________________
Do you have any physical limitations that prohibit you from performing certain types of work, or have you ever been advised by a physician not to perform certain types of work?
If yes, explain
Please give date of last complete physical:______________________
Education
Circle Last Year Month & Year of
Name/Address Completed Graduation
High School___________________________________ 1 2 3 4 ______________
_____________________________________________
College______________________________________ 1 2 3 4 ______________
____________________________________________
Grad. Work___________________________________ 1 2 3 4 _______________
Other________________________________________________________________________
List any experience, skills or qualifications which you feel would especially be important in considering you for this position:
Personal References (Not former employers or relatives)
Name & Occupation Address Tel. No.
1.__________________________________________________________________________________
2.__________________________________________________________________________________
3.__________________________________________________________________________________
IV. Past Employment
If you are presently employed, why do you desire to change your position?
Starting with present or most recent, list all previous employers. Do not, however, list more than ten years prior. Please include self-employment, summer and part-time jobs. You may use addtional paper.
From |
To |
Name of Employer
|
Start Pay |
Finish Pay |
Supervisor’s Name |
Reason For Leaving |
Address of Employer
|
Supervisor's Title |
|
Describe in detail the work you did:
From |
To |
Name of Employer
|
Start Pay |
Finish Pay |
Supervisor’s Name |
Reason For Leaving |
Address of Employer
|
Supervisor's Title |
|
Describe in detail the work you did:
From |
To |
Name of Employer
|
Start Pay |
Finish Pay |
Supervisor’s Name |
Reason For Leaving |
Address of Employer
|
Supervisor's Title |
|
Describe in detail the work you did:
May we contact the employers listed above?_________ If not, indicate which employers you do not wish us to contact
Have you ever been convicted of a criminal offense?_____________ If so, please describe:
I hereby certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal.
In processing this employment application, the Town of Hopkinton may consent to make an investigation which may include information on my personal history.
Date_____________________ Signature of Applicant______________________________________________
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