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Personal Information

First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
Are any of your relatives currently employed with the Town?*
1. Yes
1. No
If yes, please state the name of the relative and department:
Have you ever worked for the Town before?*
1. Yes
1. No
If yes, indicate Position, Department, and Dates:
Are you eligible to work in the United States?*
1. Yes
1. No
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Position Information

Which position are you applying for?*
Type of employment desired*
1. Full Time
1. Part Time
1. Seasonal
1. Internship / Volunteer
Date available to start work:*
How did you hear about the position?*
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Education

High School
Address
Diploma
College
Address
Degree
Other
Address
Degree
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Employment History

(From Most Recent)
Employer
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Employer
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Employer
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Summarize any special skills or qualifications that you have acquired from your employment or other experience:
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References

Please list three references familiar with your work history but are not family.
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
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Disclaimer & Signature

Diversity and Inclusion are Core Values at the Town of Irondequoit
The Town of Irondequoit strives to have employees that represent the community in which we serve. We believe that inclusion and diversity make Irondequoit better by providing a place where bringing together a variety of perspectives leads to greater innovation and success.
IT IS THE POLICY OF THE TOWN OF IRONDEQUOIT TO AFFORD EQUAL OPPORTUNITY TO ALL APPLICANTS FOR EMPLOYMENT WITHOUT REGARD TO AGE, RACE, RELIGION, COLOR, SEX, NATIONAL ORIGIN, MARITAL STATUS, AND SEXUAL ORIENTATION, AND TO AFFORD EQUAL OPPORTUNITIES TO INDIVIDUALS WITH A DISABILITY, VETERANS OF THE VIETNAM ERA, AND DISABLED VETERANS IN COMPLIANCE WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS.
I understand that the Town may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.
Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I declare that the statements made in this application and any accompanying papers have been examined by me and to the best of my knowledge and belief are true and correct. Any false statements, intentional misrepresentations, or omissions made may result in termination of employment or removal from eligibility. Applicants may be required to complete an "Authorization to Disclose and Release Personal Information and Release of Claims" form for purposes of a background investigation. I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying information to the Town, and I also release the Town from all liability that might result from making an investigation.
Applicant Signature*

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