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2. We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, gender identity, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.

4. Position(s) Applying for
5. Date
   Date

7. I. Personal Information

9. Last Name*
10. First Name*
11. Middle Initial
13. Pronouns (Optional)
14. Chosen Name (Optional)
16. Address*
18. City*
19. State*
20. Zip Code*
22. Phone Number*
23. Alternative Number
25. Email Address
27. Upload Resume (Optional)
28. Upload Cover Letter (Optional)

30. II. Education History

    Fill all applicable rows

32. High School Name
33. Year Completed
35. College Name
36. Year Completed
38. Tech Training
39. Year Completed
41. Other (i.e. Grad School)
42. Year Completed

44. III. Employment Record

    Please include all employment history or attach resume. If you have more than 5 entries please attach resume

    
    

46. Organization Name
47. Position
49. Start Date
    Start Date
50. End Date
    End Date
52. Organization Name
53. Position
55. Start Date
    Start Date
56. End Date
    End Date
58. Organization Name
59. Position
61. Start Date
    Start Date
62. End Date
    End Date
64. Organization Name
65. Position
67. Start Date
    Start Date
68. End Date
    End Date
70. Organization Name
71. Position
73. Start Date
    Start Date
74. End Date
    End Date

76. IV. Attestations

    Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver’s license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

78. Are you legally eligible for employment in this country?*

    1. Yes
    2. No
80. If you are under 18, and it is required, can you furnish a work permit?*

    1. Yes
    2. No
    3. N/A
82. Do you have any relatives who are presently (or have formerly been) employed by the Town of Tyngsborough?*

    1. Yes
    2. No
84. How were you referred to the Town?

86. I UNDERSTAND THAT IF I AM EMPLOYED, ANY MISREPRESENTATIONS OR MATERIAL OMISSION MADE BY ME ON ANY DOCUMENTS I HAVE PROVIDED WILL BE SUFFICIENT CAUSE FOR CANCELLATION OF THIS APPLICATION OR IMMEDIATE DISCHARGE FROM THE EMPLOYER’S SERVICE, WHENEVER IT IS DISCOVERED.

    I GIVE THE EMPLOYER THE RIGHT TO CONTACT AND OBTAIN INFORMATION FROM ALL REFERENCES, EMPLOYERS AND EDUCATIONAL INSTITUTIONS AND TO OTHERWISE VERIFY THE ACCURACY OF THE INFORMATION CONTAINED IN ANY OF THE DOCUMENTS PROVIDED. I HEREBY RELEASE FROM LIABILITY THE EMPLOYER AND ITS REPRESENTATIVES FOR SEEKING, GATHERING AND USING SUCH INFORMATION AND ALL OTHER PERSONS, CORPORATIONS OR ORGANIZATIONS FOR FURNISHING SUCH INFORMATION.

    IT IS UNLAWFUL IN MASSACHUSETTS TO ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PROSECUTION OR CIVIL LIABILITY.

    THE TOWN OF TYNGSBOROUGH DOES NOT UNLAWFULLY DISCRIMINATE IN EMPLOYMENT AND NO QUESTION ON THIS APPLICATION OR IN SUBSEQUENT INTERVIEWS IS USED FOR THE PURPOSE OF LIMITING OR EXCUSING ANY APPLICANT FROM CONSIDERATION FOR EMPLOYMENT ON A BASIS PROHIBITED BY LOCAL, STATE, OR FEDERAL LAW.

    I UNDERSTAND THAT IT IS THE TOWN’S POLICY NOT TO REFUSE TO HIRE A QUALIFIED INDIVIDUAL WITH A DISABILITY BECAUSE OF THAT PERSON’S NEED FOR A REASONABLE ACCOMODATION AS REQUIRED BY THE ADA.

    I ALSO UNDERSTAND THAT IF I AM HIRED, I WILL BE REQUIRED TO PROVIDE PROOF OF IDENTITY AND LEGAL WORK AUTHORIZATION.

    I REPRESENT AND WARRANT THAT I HAVE READ AND FULLY UNDERSTAND THE FOREGOING AND SEEK EMPLOYMENT UNDER THESE CONDITIONS

88. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
90. Electronic Signature*
Leave This Blank:


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

    This field is not part of the form submission.

94. Submit

* indicates a required field