Position You Are Applying For*required

Hourly Rate/Salary Desired

You must fill out this application completely even if a resume is being provided.

The Town of Ellington (the “Town”) is an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any basis prohibited by law. The Town considers applicants for all positions without regard to race, color, religion, gender, national origin/ancestry, age, disability, marital status, military/veteran status, sexual orientation, gender identity/expression, genetic information or any other legally protected status. The Town will provide equal opportunity in compliance with all applicable laws.

Town of Ellington

55 Main Street

P.O. Box 187

Ellington, CT 06029

Personal Information

Name*required

Please include first, middle and last name.

Email Address*required

Street Address*required

Address Line 2

Apt #, P.O. Box, etc.

City, State, Zip Code*required

Primary Phone Number*required

Work Phone Number

Are you at least 18 years old?*

Yes No

Enter Age

How did you hear about this job?

Other

May we call you at work?

Yes No

May we contact your current employer?

Yes No

Are you either a U.S. citizen or an alien authorized to work in the United States?*

Yes No

Are you prevented from lawfully becoming employed in this country because of VISA or immigration status?*

Yes No

If employment is offered, can you produce documentation required by law to establish work authorization and identity?*

Yes No

Are you currently on “lay-off” status and subject to recall?*

Yes No

Employment Desired

On what date are you available to start?*required (mm/dd/yyyy)

Are you available:

Full-time Part-time

Are there any hours or days you cannot or will not work?

Can you travel if your job requires it?

You will need to provide a valid Driver's License and proof of insurance if required to drive.

Yes No

Can you work overtime if required?

Yes No

Do you have any friends or relatives working here?

Yes No

List name and relationship to you*required

Have you ever been dismissed, involuntarily terminated or terminated by mutual agreement?

Yes No

Please explain:*required

Have you ever been asked/forced to resign or given choice to resign rather than termination?

Yes No

Please explain:*required

References

Please provide the names of three (3) professional references, not related to you, whom you have known at least one year.

1. Name and Title

Company/Business

Address

City, State, Zip Code

Phone Number

Email Address

2. Name and Title

Company/Business

Address

City, State, Zip Code

Phone Number

Email Address

3. Name and Title

Company/Business

Address

City, State, Zip Code

Phone Number

Email Address

Education

Have you graduated from high school or received a high school equivalency diploma?

Yes No

Select the highest grade completed:

Enter High School Name:

Higher Education Information

If multiple higher education institutions were attended, please fill out additional fields.

School Type

Technical/Trade or Business College/University Graduate/Professional

School Name

City, State, Country (if not US)

Course of Study

# of Years Completed

Did you receive a degree/diploma?

Yes No

List degree/diploma details:

School Type

Technical/Trade or Business College/University Graduate/Professional

School Name

City, State, Country (if not US)

Course of Study

# of Years Completed

Did you receive a degree/diploma?

Yes No

List degree/diploma details:

School Type

Technical/Trade or Business College/University Graduate/Professional

School Name

City, State, Country (if not US)

Course of Study

# of Years Completed

Did you receive a degree/diploma?

Yes No

List degree/diploma details:

Training/Licenses/Certifications

Describe any specialized training, licenses, certifications and skills:

Has any license/certification you have held been surrendered, suspended or revoked for any reason?

Yes No

Please explain:

State any additional information you feel may be helpful to us in considering your application:

Do you or have you served in the Armed Forces, Reserves, National Guard or other uniformed services?

Yes No

Provide details of your service (branch, dates, characterization of discharge, etc)

Employment Experience

You must fill out this section completely even if a resume is being provided.
Starting with your most recent employment, provide your complete employment history for the past 10 years. Include any job-related military service assignments and volunteer activities. Please be aware that your current and previous employers may be contacted.

Employer

Job Title

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Employer Address

City, State, Zip Code

Phone Number 1

Phone Number 2

Duties & Accomplishments

Supervisor Name & Title

Reason for leaving:

Employer

Job Title

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Employer Address

City, State, Zip Code

Phone Number 1

Phone Number 2

Duties & Accomplishments

Supervisor Name & Title

Reason for leaving:

Employer

Job Title

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Employer Address

City, State, Zip Code

Phone Number 1

Phone Number 2

Duties & Accomplishments

Supervisor Name & Title

Reason for leaving:

NOTICE TO APPLICANTS REGARDING PRE-EMPLOYMENT DRUG AND/OR ALCOHOL TESTING

Any individual applying for employment with the Town of Ellington (“The Town”) may be required to submit to a urinalysis drug test or alcohol testing as a mandatory part of the employment application process. This notice serves as a written statement of the Town’s intention to conduct drug and/or alcohol testing as part of the application process. The testing will be conducted in accordance with the procedures required by applicable state and federal regulations. Tested applicants will be given a copy of any positive test result. All test results shall be considered confidential by the Town and shall not be disclosed to the employees of the Town, or any other person, other than to those persons for whom such disclosure is necessary or as otherwise required by law. Positive test results, or a refusal to sign this consent form and participate in pre-employment drug and/or alcohol testing, shall be grounds for denial of employment. Arrangements for testing will be made by a representative of the Town, in consultation with each applicant. Cooperation in scheduling the testing is important for processing an application.

By signing below, you consent to be drug and/or alcohol tested and acknowledge you have thoroughly read the foregoing notice and policy, and you understand and agree that in order to be considered for employment with the Town, you will comply in full with the Town’s drug and alcohol policies.

Applicant's Electronic Signature*required

Today's Date (mm/dd/yyyy)

AT-WILL EMPLOYMENT DISCLAIMER AND APPLICANT'S AGREEMENT AND CERTIFICATION

I certify that the answers given in this application are true to the best of my knowledge. I understand that the use of this application form does not indicate that there are any positions open and does not in any way obligate the Town of Ellington (hereafter “the Town”) to employ me.

In the event I become employed and in consideration of my employment, I agree to conform to the policies and procedures of the Town, as they may from time to time be implemented or revised, and that unless I am covered by an applicable collective bargaining agreement or individual written contract, my employment and compensation are “at-will” and that my employment can be terminated with or without cause at any time for any lawful reason at the option of either the Town or myself. I understand that should I be granted an interview, no representations that may be made at the interview are to be construed as creating any obligation, promise or contract on behalf of the Town that in any way would limit the Town’s right to terminate my employment at will. I understand that no supervisory, management or any other employee at the Town has any authority to make a commitment of guaranteed or continuing employment to me, and no document or publication of the Town or conduct of anyone at the Town should be interpreted to make such a guarantee.

I understand that false or misleading information given in my application, resume, interview or during the course of my employment may result in withdrawal of a job offer or discipline up to and including termination of employment, whenever the omission or falsehood is discovered. I understand that acceptance for employment shall depend on satisfactory replies from my references and any other required background checks or pre-employment tests. I understand that if I am paid a weekly salary rather than an hourly rate, my salary is intended to compensate me for all hours I work, including any hours in excess of 40 hours in a work week.

I have read, understood and agree to the foregoing.

Applicant's Electronic Signature*required

Today's Date (mm/dd/yyyy)

Attach Resume*required

Max file size: 10 MB

Attach Cover Letter

Max file size: 10 MB

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Please provide an email address where we can send a link to your current form.

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