Fillable Employment Application 2018 FILL IN (City of Beverly MA)

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Employment Application 2018 FILL IN (City of Beverly MA)

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The Employment Application 2018 FILL IN (City of Beverly MA) form is 3 pages long and contains:

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  • 19 check-boxes
  • 76 other fields

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File type: PDF

U.S.A. forms for City of Beverly MA

BROWSE CITY OF BEVERLY MA (MA) FORMS

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1
City of Beverly
APPLICATION FOR EMPLOYMENT
DEPARTMENT of HUMAN RESOURCES
191 Cabot Street
Beverly, MA 01915
Telephone (978) 921-6000
Fax (978) 921-8589
The City of Beverly is an Equal Opportunity/Affirmative Action Employer and does not discriminate against any applicant
because of race, color, religion, sex, marital status, national origin, age, disability, genetic information, sexual orientation,
gender identity, uniformed military service, or any other class protected by federal, state or local law. Any person who needs
assistance in fully participating in the application process should contact the City of Beverly Human Resources Department.
General Information
Position Applied For:
Date of Application:
FULL TIME
PART TIME
How did you hear about this position?
If position is part time, what hours are you available? If position is full time, are you available for:
Mon – Fri Weekends Overtime?
YES NO 1
st
2
nd
3
rd
shift? (please circle)
Applicant Information
Name:
First
Middle
Address:
Number
Street
Apt. Number
City/Town
State
Zip Code
Telephone Number:
Preferred:
Other:
Area Code/Number
Area Code/Number
E-mail Address:
Are you currently or have you ever been employed by the City of Beverly?
YES NO
If yes: Date of Hire?
In which Department?
Do you have any relatives working for the City of Beverly?
YES
NO
If yes: Name of Relative(s)
Are you fluent in another language?
YES
NO
If yes, which language(s)
Have you served in the military?
YES
NO
If yes, which branch
Final Rank:
Skills & Qualifications
Summarize any relevant skills, licenses and/or certificates which may assist you in the position for which you are applying:
2
Education
High School
Name:
# Years
Completed:
Location:
Did you graduate?
YES
NO
College / Graduate Level
Name:
# Years
Completed:
Location:
Did you graduate?
YES
NO
Course of Study:
Degree:
Course of Study:
Degree:
Employment History
Starting with your most recent employer, please provide the following information:
(NOTE: any verifiable work performed on a volunteer basis may also be included)
Employer:
Telephone:
Employment Dates:
Street
Address:
City/State:
to
Position held: Immediate Supervisor:
Reason(s) for leaving:
Describe the work performed:
Employer:
Telephone:
Employment Dates:
Street
Address:
City/State:
to
Position held: Immediate Supervisor:
Reason(s) for leaving:
Describe the work performed:
Employer:
Telephone:
Employment Dates:
Street
Address:
City/State
to
Position held: Immediate Supervisor:
Reason(s) for leaving:
Describe the work performed:
3
Personal References
Please provide the name, address & telephone numbers of three individuals (not related to you):
Name:
Address:
Telephone #:
Name:
Address:
Telephone #:
Name:
Address:
Telephone #:
The information provided in this application for employment is true and complete to the best of my knowledge. I understand
I may include any other information which may be helpful, such as work experiences, skills, articles/books published,
activities, accomplishments, skills, verifiable volunteer participation, or experience acquired in the U.S. Armed Services, etc. I
understand that any misrepresentation of information as part of the application process may result in immediate rejection of
this application or dismissal from employment.
This application is not a contract of employment. Acceptance of this application by the City of Beverly does not mean that
the applicant will be employed.
I authorize investigation of all statements contained in this application and the release of any pertinent information regarding
my education, past employment history and background. I authorize the City of Beverly to obtain any information from
schools, employers or individuals relating to my qualifications or past activities. This information may include, but is not
limited to: academics, achievement, performance, attendance, personal history and discipline. Further, I hereby authorize all
references, persons, schools, my current employer (if applicable) and previous employers and organizations named in this
application, unless otherwise stated, to provide the City of Beverly any relevant information that may be required to arrive at
an employment decision. I understand that the information released is for the City of Beverly’s use only.
I hereby voluntarily release, discharge and exonerate the City of Beverly, its agents and representatives, and any person so
furnishing information from any and all liabilities, of every nature and kind, arising out of the furnishing or inspection of such
documents, records and other information, or the investigations made by or on behalf of the City of Beverly.
If required for the position I am seeking, I agree to take a physical examination, which may include testing for drugs or a
psychological examination, as required, and recognize that any offer of employment may be contingent upon the results of
such an examination.
I understand that the City of Beverly may also perform a criminal background check on prospective applicants whom are
otherwise qualified and to whom the City makes a conditional offer of employment. In such cases, I understand that a final
offer of employment will be dependent on a successful criminal background check.
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States
and to complete the required employment eligibility verification document form upon hire.
In the event of my employment with the City of Beverly, I will comply with all rules, regulations and policies set forth by the
City of Beverly.
Nothing in this application limits the City’s ability to conduct any background check, reference check, or any other pre-
employment check or inquiry in accordance with law.
I represent that I have read and fully understand the foregoing and seek employment under these conditions.
Signature: Date: ________________________
“It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An
employer who violates this law shall be subject to criminal penalties and civil liability.” –
MGL Ch.149, Section 19B
1/18
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Employment Application 2018 FILL IN (City of Beverly MA)

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Completed 20 July 2020

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