Employment

Job Application

Application for Employment

Applicants for employment are considered without regard to race, color, religion, sex, protected sexual orientation, marital status, veteran's status, national origin, ancestry, age or handicap. Also it is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Personal Information

First Name:*
Last Name:*
Middle Initial:

Address

Street/PO Box:*
City:*
State:*
Zip:*
Phone:*
E-mail:*
Are you under 18?:
If employed and you are under 18, can you furnish a work permit?:
Have you ever been employed here before?:
If yes, when? (mm/dd/yyyy):
Are you employed now?:
May we contact your present employer?:
Do you have the legal right to work in the United States?:*

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Referred By

Select One:*
If Other Please Specify:

Position(s) Applying for

Please choose 1-3 positions:*

Work Availability

To help us consider you for a job that matches your availability please let us know what days and hours you can work each day.

Hours:*
Shift:

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Why Wachusett?

Please take a few minutes to tell us why you've chosen Wachusett for a possible place of employment and what you think you can contribute as a staff member towards even better customer service.

Why did you choose Wachusett?:*

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References

Give name, address and telephone number of three references who are not related to you and are not previous employers.

References:*

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Previous Employers

Start with your present or last job. Include military service assignments and any verified work performed on a volunteer basis. Exclude organization name which indicate race, color, religion, sex or national origin.

Employer 1

Employer:
Address:
Supervisor:
Employed From:
Employed To:
Reason for Leaving:
Work Performed:

Employer 2

Employer:
Address:
Supervisor:
Employed From:
Employed To:
Reason for Leaving:
Work Performed:

Employer 3

Employer:
Address:
Supervisor:
Employed From:
Employed To:
Reason for Leaving:
Work Performed:

Employer 4

Employer:
Address:
Supervisor:
Employed From:
Employed To:
Reason for Leaving:
Work Performed:

Special Skills and Qualifications:

Summarize special skills and qualifications acquired from employment or other experience.

Special Skills and Qualifications:

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Education

High School

Name of High School:
Years Completed:
Diploma/Degree:
Describe Specialized Training, Apprenticeship, Skills and Extra Curricular Activities:

College/University

Name of College/University:
Years Completed:
Diploma/Degree:
Describe Specialized Training, Apprenticeship, Skills and Extra Curricular Activities:

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Verification

Wachusett Mountain Associates, in considering my application for employment, may verify the information set forth on this application and obtain additional information relating to my background. I authorize all persons, schools, companies, corporations, credit bureaus and law enforcement agencies to seek any information concerning my background. I have read, understand, and agree to this statement.

I certify that the information on this application is correct and I understand that any misrepresentation or omissions of any information will result in my disqualification from consideration for employment or, if employed, my dismissal. I understand that this application is not a contract, offer, or promise of employment and that if hired I will be able to resign at any time for any reason. Likewise, Wachusett Mountain Associates can terminate my employment at any time with or without cause. I have read, understand and agree to this statement.

Full Name:*
Today's Date:*

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