Town of Clyde Employment Application
Email address
Date of Application
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Position(s) Applied For
Your answer
Referral Source:
Name: (Last, First, Middle)
Your answer
Address:
Your answer
Telephone: (Including Area Code)
Your answer
Driver's License Number:
Your answer
Social Security Number:
Your answer
If employed and you are under 18, can you furnish a work permit?
Have you filled out an application here before?
If yes, give date:
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Have you ever been employed here before?
If yes, give date:
MM
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DD
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YYYY
Are you employed now?
May we contact your present employer?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status may be required upon employment
On what date would you be available for work?
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DD
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YYYY
Are you available to work?
Required
Are you on a lay-off and subject to recall?
Required
Can you travel of a job requires it?
Required
Have you been convicted of a felony in the last 7 years?
Required
If yes, please explain:
Your answer
Are you a veteran of the U.S. military?
If yes, Branch?
Your answer
Do you have any physical, mental or medical impairments or disabilities that would limit your job performance in the position for which you are applying?
If yes, please explain:
Your answer
Are there workplace accommodations which would assure better job placement and/or enable you to perform your job to your maximum capability?
If yes, please indicate:
Your answer
Please list any foreign languages and indicate if you speak, read and or write:
Your answer
If you speak, read or write a foreign language please indicate your level of fluency:
List professional, trade, business or civic activities and offices held.
Exclude those which indicate race, color, religion, sex or national origin.
Your answer
Give name, address, and telephone number of three references who are not related to you and are not previous employers.
Your answer
Special Employment Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals with Physical or Mental Handicaps.
Government contractors are subject to Section 402 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals. If you are a disabled veteran or have a physical or mental handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect any consideration you may receive for employment. If you wish to be identified, please indicate below:
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