Haddam-Killingworth
Recreation Department APPLICATION FOR EMPLOYMENT
95
Little
Position(s)
Applying For:
____________________________________________________________________
Full
Name _______________________________________e-mail
address______________________________
Address
_____________________________________Town_________________________________________
Phone ________________________Social Security
#______________________ Are you 16 or
older?______
1. Are you currently employed?
____________ May we contact your present
employer? ______
2. On what date would you be available to
start work? _________________________________
3. Do you have transportation to and from
work? _____________________
4. EDUCATION: High School College Other
School Name _______________ _______________ _________________
Graduation Date or
Anticipated Grad.
Date ________________ _______________ _________________
Course of Study ________________ _______________ _________________
Describe any honors you have received:
___________________________________________________
5. Describe any special certification you have received (CPR,
1st Aid, Lifeguard Training, etc.)
___________________________________________________________________________________.
6. List any special skills you have (art, music, sports,
languages, etc. BE SPECIFIC):
____________________________________________________________________________________
7. Describe something you have accomplished and are proud of:
__________________________________
____________________________________________________________________________________
8. REFERENCES:
A. Give
name, address and telephone number of one reference who is not related to
you,
not a teacher, or not a previous
employer:
______________________________________________________________________________
(OVER)
B. If you
are a Middle School or High School Student, you must have one teacher
who will
give a character reference for you. You must have the teacher's signature.
Teacher's
9. EMPLOYMENT
EXPERIENCE:
I. Employer _________________________________________ Phone ____________________
Address
_______________________________________________________________________
Job Title/Work Performed
_________________________________________________________
Pay Rate __________________ Start Date/End Date__________/___________
Supervisor's Name
__________________________________________
Reason for Leaving ______________________________________________________________
II. Employer
______________________________________ Phone____________________
Address
_______________________________________________________________________
Job Title/Work Performed
_________________________________________________________
Pay Rate __________________ Start Date/End Date__________/___________
Supervisor's Name
_______________________________
Reason for Leaving
______________________________________________________________
If you wish to include more
details, attach resume.
10. Have you ever been convicted of any crime, including sex
related or child abuse related offenses?
____________Yes ____________No
If yes, explain:________________________________________________________________________
____________________________________________________________________________________
I certify that answers given herein are true and
complete to the best of my knowledge. I
authorize investigation of all statements contained in this application for
employment as may be necessary in arriving at an employment decision.
___________________________________________ ___________________
Signature Date
We are an Equal Opportunity
Employer in accordance with Title IX regulations.