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Personal Information

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job related medical condition or handicap.
Date of Application
Date of Application
First Name*
Middle Name
Last Name*
Address*
City*
State*
Zip*
P.O. Box / Mailing Address
Home Phone Number*
Cell Phone Number*
Email Address*
Applicant must provide a copy of Social Security Card and official identification at hiring.
Under 18 years old?
1. Yes
1. No
If under 18 years old, how many hours are you available to work?
Have you previously been employed by the Town of Wellington?
1. Yes
1. No
If yes, please give dates.
If yes, please give dates. Start Date
—
If yes, please give dates. End Date
Are you employed now?
1. Yes
1. No
If hired, on what date would you be available to work?
If hired, on what date would you be available to work?
Are you a veteran of the United States Military?
1. Yes
1. No
What branch?
Date of Service
Date of Service Start Date
—
Date of Service End Date
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Position Information

Which position are you applying for?*
Referral Source
1. Advertisement
2. Friend
1. Internet
2. Relative
1. Walk-In
2. Other
If other, please specify:
Type of employment desired*
1. Full Time
1. Part Time
1. Internship
Salary desired*
Hours of work (per week) desired*
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Education

High School or GED
Check last year completed (GED):
1. 9
2. 10
1. 11
2. 12
High School Diploma Received?
1. Yes
1. No
College or University
Degree
Number of Years Completed
Address
City
State
Zip Code
Vocational or Technical Training
Degree
Number of Years Completed
Address
City
State
Zip Code
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Special Skills & Experience

Employment History

Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names, which indicate race, color, religion, sex, or national origin.
Company
Job Title
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Job Description
Reason for Leaving
Employed From - To (Date)
Starting Hourly Rate
Ending Hourly Rate
Company
Job Title
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Job Description
Reason for Leaving
Employed From - To (Date)
Starting Hourly Rate
Ending Hourly Rate
Company
Job Title
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Job Description
Reason for Leaving
Employed From - To (Date)
Starting Hourly Rate
Ending Hourly Rate
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References

Please list three professional references.
Full Name*
Relationship*
Address
City
State
Zip Code
Email Address*
Phone Number*
Full Name*
Relationship*
Address
City
State
Zip Code
Email Address*
Phone Number*
Full Name*
Relationship*
Address
City
State
Zip Code
Email Address*
Phone Number*
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Upload Documents

Resume
Upload your resume here.
Cover Letter
Upload your cover letter here.
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Disclaimer & Signature

Affidavit
Please read each statement carefully before signing.

I certify that all information provided in this employment application is true and complete. If I am selected for interview, I understand that I must inform the Town of Wellington of any changes in the information I have provided on this application. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at any later date.

I understand that the Town of Wellington may conduct an extensive and thorough background investigation.

I authorize the Town of Wellington and/or any of its agents to verify and investigate any or all statements contained in this application. I also authorize any person, school, current employer (except as previously noted), past employers, law enforcement authorities, and organizations named in this application to provide and release any information and opinions concerning my background. I release such persons and organizations from any legal liability for any damage whatsoever for making such statements.

I understand that use of illegal drugs is prohibited during employment. I will be required to successfully pass a drug and alcohol screening examination prior to being hired, and I consent to taking a drug and alcohol test at any time during my employment, should I be hired.

I understand that I may be required to obtain a recent credit report displaying credit history which must be presented with and as a part of the employment application.

I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time.

I further certify that I have read and understand the instructions, conditions, and other information provided in this document.
Applicant Signature*
Date
Date

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Email address

This field is not part of the form submission.
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