Form Center

Step One

TOWN OF GRANBY
APPLICATION FOR EMPLOYMENT
15 North Granby Road
Granby, CT 06035
AN EQUAL OPPORTUNITY EMPLOYER
State law prohibits job discrimination on the basis of age, race, color, sex, marital status, religious creed, sexual orientation, national origin, ancestry, past or present mental disorder, mental retardation, learning disability or physical disability unless they are bona fide occupational qualifications.
Position Applied For:
Date of Application
Date of Application
Attach Resume If Available
First Name
Last Name
Email Address
Address
City
State
Zip Code
Home Phone Number
Cell Number
If you are under 18 years of age, can you provide required proof of your eligibility to work?
1. Yes
1. No
Have you ever filed an application with the town before?
1. Yes
1. No
If yes, give date(s)
If yes, give date(s)
Have you ever been employed with us before?
1. Yes
1. No
If yes, give dates
If yes, give dates Start Date
—
If yes, give dates End Date
Do any of your friends or relatives, other than spouse, work here?
1. Yes
1. No
Are you currently employed?
1. Yes
1. No
May we contact your present employer?
1. Yes
1. No
Are you prevented from lawfully becoming permanently employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment.
1. Yes
1. No
Are you available to work:
select all that apply
1. Full Time
2. Part Time (Mornings)
3. Part Time (Afternoons)
1. Part Time (Evenings)
2. Temporary
On what date would you be available for work?
On what date would you be available for work?
Continue

Step Two

Education
High School
School Name
Address
City
State
Zip Code
Course of Study
Years Completed
Diploma/Degree
Undergraduate College
School Name
Address
City
State
Zip Code
Course of Study
Years Completed
Diploma/Degree
Graduate/Professional
School Name
Address
City
State
Zip Code
Course of Study
Years Completed
Diploma/Degree
Other (Specify)
School Name
Address
City
State
Zip Code
Course of Study
Years Completed
Diploma/Degree
Describe any specialized training, apprenticeship, skills and extra-curricular activities:
List professional, trade, business or civic activities and offices held.
You may exclude membership, which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.
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Step Three

Employment Experience
List all employment including self-employment, summer, part-time and full-time military service. You may also include any work performed on a volunteer basis. Start with the present or most recent employer.
Company Name
Phone Number
Supervisor
Address
City
State
Zip Code
Job Title
Dates of Employment
Dates of Employment Start Date
—
Dates of Employment End Date
Job Status
1. Full-Time
1. Part-Time
Description of Duties
Reason for Leaving
Company Name
Phone Number
Supervisor
Address
City
State
Zip Code
Job Title
Dates of Employment
Dates of Employment Start Date
—
Dates of Employment End Date
Job Status
1. Full-Time
1. Part-Time
Description of Duties
Reason for Leaving
Company Name
Phone Number
Supervisor
Address
City
State
Zip Code
Job Title
Dates of Employment
Dates of Employment Start Date
—
Dates of Employment End Date
Job Status
1. Full-Time
1. Part-Time
Description of Duties
Reason for Leaving
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Step Four

Additional Information
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
Specialized Skills
List any specialized skills that could be related to the position you are applying for. For example, Microsoft Word, Excel, etc.
List any licenses or certifications you hold which are valid and in good standing:
State any additional information you feel may be helpful to us in considering your application:
References
Name
Email Address
Address
City
State
Zip Code
Home Phone Number
Cell Number
Name
Email Address
Address
City
State
Zip Code
Home Phone Number
Cell Number
Name
Email Address
Address
City
State
Zip Code
Home Phone Number
Cell Number
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Step Five

Are you capable of performing, with or without reasonable accommodation, the essential functions of the job or occupation for which you have applied? A description of the activities involved in such a job or occupation is attached.
1. Yes
1. No
A Note to Applicants: DO NOT ANSWER THE FOLLOWING QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS ON THE JOB FOR WHICH YOU ARE APPLYING.
Electronic Signature Agreement
By checking the "I agree" box I certify the above information is correct and truthful. I realize, too, that falsification of any information on this application may be grounds for rejection of this application, or termination of employment, depending upon when the falsification is discovered. I also give consent for you to check with previous employers and personal references and release the town, previous employers and personal references from any liability arising from disclosure of information concerning my past employment or personal history. I further understand the acceptance of this form does not constitute an employment agreement. Failure to completely fill out this application may result in my disqualification from any further consideration for employment.
I hereby acknowledge that I have read the above statements and understand them.
1. I agree.
Electronic Signature
The Town of Granby reserves the right to reject any or all applications, which may be deemed in its best interest to do so.

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1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Job Application

Steps

Step One

TOWN OF GRANBY

APPLICATION FOR EMPLOYMENT

15 North Granby Road

Granby, CT 06035

AN EQUAL OPPORTUNITY EMPLOYER

Step Two

Education

High School

Undergraduate College

Graduate/Professional

Other (Specify)

Step Three

Employment Experience

Step Four

Additional Information

References

Step Five

Contact Us

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