Form Center

2. 
3. City of Winooski Employment Application
5. Applicant Information
7. Today's Date*
   Today's Date
8. First Name*
9. Middle Name
10. Last Name*
12. Phone Number*
13. Email*
14. Address*
16. City*
17. State*
18. Zip Code*
20. Position You're Applying For*
21. Where Did You Hear About This Position?*
    -- Select One --winooskiv.govSocial MediaSeven DaysIndeed.comCraigslistOther
22. Are You Eligible to Work in the United States?*

    1. Yes
    2. No
23. Does This Position Require a CDL?

    1. Yes
    2. No
25. Have You Ever Worked for the City of Winooski Before?*

    1. Yes
    2. No
26. If Yes, When?
    If Yes, When?
27. Do You Have Relatives Who Work for the City of Winooski?*

    1. Yes
    2. No
28. If Yes, Who?
32. Education
34. Name of High School Attended*
35. How Many Years Did You Attend?*
36. Have You Graduated?*

    1. Yes
    2. No
38. Address
40. City
41. State
42. Zip Code
44. Name of College Attended
45. How Many Years Did You Attend?
46. Have You Graduated?

    1. Yes
    2. No
48. Address
50. City
51. State
52. Zip Code
54. Other School
55. How Many Years Did You Attend?
56. Did You Graduate?

    1. Yes
    2. No
60. Employment
62. Name of Current Employer*
63. Dates Employed*
    Dates Employed Start Date

    —

    Dates Employed End Date
64. Responsibilities *
66. Reason for Leaving*
67. Name of Supervisor*
68. May we Contact this Employer and or Supervisor for a Reference?*

    1. Yes
    2. No
70. Name of Previous Employer*
71. Dates Employed*
    Dates Employed Start Date

    —

    Dates Employed End Date
72. Responsibilities*
74. Reason for Leaving*
75. Name of Supervisor*
76. May we Contact this Employer and or Supervisor for a Reference?*

    1. Yes
    2. No
78. Name of Previous Employer*
79. Dates Employed*
    Dates Employed Start Date

    —

    Dates Employed End Date
80. Responsibilities*
82. Reason for Leaving*
83. Name of Supervisor*
84. May we Contact this Employer and or Supervisor for a Reference?*

    1. Yes
    2. No
88. Professional References
90. Full Name*
91. Relationship*
92. Phone*
93. Email*
95. Company*
96. Address*
98. Full Name*
99. Relatonship*
100. Phone*
101. Email*
103. Company*
104. Address*
106. Full Name*
107. Relationship*
108. Phone Number*
109. Email Address*
111. Company*
112. Address*
116. Additional Information
118. Please list any other relevant certifications, skills, education, training or licenses you possess:*
120. Did You Serve in the Military?
121. What Branch?
122. Rank at Discharge
124. Military Experience Relevant to Position Applied for:
126. Non-Discriminiation Policy
     It is the policy of this Municipality to provide equal opportunity to apply to all applicants and employees without regard to race, color, religion, sex, national origin, ancestry, place of birth, age, marital status, pregnancy status, genetic information, physical or mental condition, HIV status, veteran status, sexual orientation, gender identity, or other category protected by state or federal law. No question is asked on this application or during the application process for the for the purpose of excluding any applicant due to the aforementioned protected categories or other category protected by law.
128. Disclaimer and Signature
     I understand omissions or misrepresentati ons may be cause for rejection or, if employed, may be cause for immediate dismissal. I hereby authorize any former employer, person, firm, corporation or educational institution listed heron including this municipality to answer any and all questions, provide documents and agree to hold all persons harmless for giving any and all truthful information within their knowledge or records. I understand this is a preliminary application and not a contract for employment. Furthermore, in the event I am hired, my employment shall be completely voluntary and may be terminated at will at any time for any non-discriminat ory reason upon notice by either myself or the municipality. I agree to comply with all reasonable rules of the municipality and condition of employment.
130. Upload You Resume*
132. By clicking yes, I hereby attest that all information provided by me is true and correct to the best of my knowledge.*

     1. Yes
133. Full Name*
134. Today's Date*
     Today's Date
Leave This Blank:


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

     This field is not part of the form submission.

138. Submit Submit and Print

* indicates a required field