Form Center

Step One

Position Sought
Available Start Date
Available Start Date
Are you currently employed?
1. Yes
2. No
Name of Employer
Employers Address
City
State
Zip Code
Full-time or Part-time
1. Full-time
2. Part-time
Email Address
City
State
Zip Code
Have you worked for the Town previously?
1. Yes
2. No
If yes, what are the dates?
If yes, what are the dates? Start Date
—
If yes, what are the dates? End Date
In What Capacity
Supervisors name
Have you previously applied for a job in the Town of Clinton?
1. Yes
2. No
If yes, when
If yes, when
For what position
Do you currently possess a valid State of Connecticut motor vehicle license?
1. Yes
2. No
Class
Do you have a concern if overtime is mandatory?
1. Yes
2. No
Are you able to perform the essential functions of the job for which you are applying – with or without a special accommodation?
1. YES
2. NO
Continue |Go Back

Is there anything in your background that would cause the Town of Clinton concern regarding your desire to become an employee of the Town? If so, please explain:
Education
High School Name Name and Location
High School Graduate and/or Degree?
High School Major/Subjects of Study
College or University Name and Location
College or University Graduate and/or Degree?
College or University Major/Subjects of Study
Specialized Training, Trade School Name and Location
Specialized Training, Trade School Graduate and/or Degree?
Specialized Training, Trade School Major/Subjects of Study
Other Education Name and Location
Other Education Graduate and/or Degree?
Other Education Major/Subjects of Study
Please list your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing the above mentioned position.
Continue |Go Back

Please provide three references other than previous employers whom we may contact.
Name
Relationship
Phone Number
Name
Relationship
Phone Number
Name
Relationship
Phone Number
Continue |Go Back

Certification
I certify that all statements made by me on this application are complete and true to the best of my knowledge and I have not withheld any pertinent information. I understand if I knowingly make any misstatement of facts, I am subject to disqualification or dismissal and to such other penalties as may be prescribed by law. I also understand that application and appointment to a temporary position is no guarantee of appointment to a permanent position. I also understand that I must successfully pass the required qualifying test(s) for this position, including a pre-employment medical exam and physical agility test, if job related, and a drug-screening test. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from liability when responding to inquiries with my application.
Signed
Applicant
Date Signed
Date Signed
The Town of Clinton is an Equal Opportunity Employer. The Town of Clinton does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law.

Leave This Blank: