Equal Opportunity Employer / Affirmative Action Employer

Examples: Teachers Certification, RN, CPA, Holsters License, CDL,etc.

Describe all work experience in detail, beginning with your current or most recent job. Include internships, job related volunteer work, and any gaps in employment. All information in this section must be completed. Resumes and cover letters may be attached to provide additional information.

I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests. By signing this document I am agreeing to release any and all records of employment including but not limited to my personnel file.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.

I understand that the foregoing will be verified in order to expedite my application for employment with the Town of East Longmeadow. I hereby authorize the town to conduct a full investigation into my background. I authorize the town to obtain my previous work records, character references and any other information concerning character, ability and habits and all other information the town deems necessary. Further, I grant the authority of the keeper of these records to release said records to the Town of East Longmeadow for the purpose of making its hiring decision. I agree that the town shall not be liable in any respect if a job offer is not extended, is withdrawn, or my employment is terminated because of false statement, omissions or answers made by me on this application. I agree that my previous employer shall not be liable with regard to any information provided by them in connection with this release. I certify under the pains and penalty of perjury that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing, which, if disclosed, would affect this application unfavorably. I understand that any false statement, omissions or answers made by me on this application can result in my immediate termination. In compliance with the Immigration and Reform and Control Act of 1986, I understand that I will be required to provide approved documentation that verifies my right to work in the United States on or before my first day of employment. I have received the list of approved documents with this application. I understand that unless I attain permanent status pursuant to MGL Chapter 31, I am subjest to terms of a collective bargaining agreement, my employment will be at-will, which means that both the Town of East Longmeadow and I are free to terminate the employment relationship at any time for any non-statutorily prohibited reason or for no reason at all, with or without notice. I hereby acknowledge that I have read in full and understand the above statements and conditions of employment.

In compliance with the Immigration and Reform and Control Act of 1986, you will be required to provide approved documentation that verifies your right to work in the United States prior to beginning work here at this agency. Please be prepared to provide any of the Following documentation if you are offered and accept a position with us: List A - Any 1 (one) of the following documents that establish both identity and employment authorization. 1. U.S. Passport or U.S. Passport Card 2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551) 3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine readable immigrant visa 4. Other approved documentation as indicated on I-9 Form List B – Any 1 (one) of the following documents that establish identity in combination of any 1 (one) document from List C: 1. State issued driver’s license or photo ID 2. Photo ID by federal, state or local government 3. School ID with photograph 4. Other approved documentation as indicated on I-9 Form List C – Any 1 (one) of the following documents that establish employment authorization in combination of any 1 (one) document from List B: 1. Social Security Card 2. Birth certificate 3. Other approved documentation as indicated on I-9 Form

If employed, I agree to abide by all rules and regulations of the Town of East Longmeadow. I understand if convicted of a felony, I will notify my supervisor immediately. I agree to furnish such additional information and complete such examination as may be required to complete an employment process and understand that this application for employment in no way obligates the town to employ me. I understand that the town will, if applicable, review the Criminal Offender Record Information (CORI) and the Central Registry of Child Abuse/Neglect reports in accordance with M.G.L., Chapter 119, Section 51B.

If an offer of employment is made to you, the town may specify that it is contingent upon the results of a medical exam. I freely and voluntarily agree to submit to a pre-employment physical and/or drug screen, as it relates to the requirement of a specific job, as part of my pre-employment application to the Town of East Longmeadow. I understand that either refusal to submit to such screening or failure to qualify according to the minimum standards established by the town for this screening may disqualify me from further consideration for employment. Further, I understand that any positive drug test results will be communicated in a confidential manner. I hereby acknowledge that I have read in full and understand the above statements.