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First Name*
Middle Name
Last Name*
Address*
City*
State*
Zip*
Phone Number*
Email Address*
Are you eligible to work in the United States?*
1. Yes
1. No
Do you currently have a valid driver's license?
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(From Most Recent) Please list your work experience for the past five (5) years beginning with your most recent job held. If you were self-employed, give firm name.
Company
Position
Phone Number
May we contact your previous employer?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Reason for leaving
Company
Position
Phone Number
May we contact your previous employer?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Reason for leaving
Company
Position
Phone Number
May we contact your previous employer?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Reason for leaving
Have you ever been in the armed forces?
1. Yes
2. No
Specialty?
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I certify that all the information on this application is accurate and complete to the best of my knowledge and understand that misleading or false statements will constitute sufficient cause for refusal of hire or termination of my employment. I understand that neither the acceptance of this application nor the subsequent entry into any type of employment relationship with Town of Capitol Heights creates an actual or implied contract of employment. I agree to submit to drug and alcohol testing, as required by the Town of Capitol Heights. I release the Town of Capitol Heights, and its employees, plus other persons or companies, from any and all liability arising out of or related in any way to such testing. I authorize the Town of Capitol Heights to investigate information concerning my education, employment experiences and all other aspects of my background relevant to my proposed employment. I release the Town of Capitol Heights and its employees from all liability arising from such investigation.
Applicant Signature*
The Town of Capitol Heights is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability.

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