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2. Town of Colchester Employment Application
   Fields with an asterisk (*) are required
4. 1. GENERAL INFORMATION
6. Today's Date*
7. Position for which you are applying *
9. If you are responding to an ad, where did you see it?

   1. Seven Days
   2. Indeed
   3. Town Website
   4. VLCT Job Posting
   5. Burlington Free Press Classifieds
11. Other (specify)
13. If you were referred by a Colchester Town employee, please tell us by whom
15. 2. PERSONAL INFORMATION
17. First Name *
18. M.I.
19. Last Name*
21. Street or P.O. Box*
23. City*
24. State*
25. Zip*
27. Home Phone
28. Cell*
30. Your Email Address*
31. If you have applied to the Town of Colchester before, provide date
33. If you have worked for the Town of Colchester before, please provide dates of employment
35. From
36. To
38. Date you will be available to start work *
40. 2a. MILITARY SERVICE
42. Are you a U.S. military veteran?

    1. Yes
    2. No
44. Branch:
46. Dates of Service:
47. From
48. To
50. Military training | Experience relevant to position applied for:
52. 2b. CITIZENSHIP / PERMISSION TO WORK IN U.S.
54. Are you a U.S. Citizen? *

    1. Yes
    2. No
56. If not, can you submit proof that you are authorized to work in the U.S. under federal law? *

    1. Yes
    2. No
58. (If hired, you must furnish valid documentation that you are legally entitled to work in the U.S.)
60. 3. EDUCATION
62. High School (Name of school)*
64. Vocational (Name of school)
65. Last Grade Completed*
67. University | College (Name of school)
68. Level Completed
70. Diplomas | Degrees (Check all that apply)*

    1. HS Diploma / GED
    2. Certification
    3. License

    1. Associate's Degree
    2. Bachelor's Degree

    1. Masters Degree
    2. Doctorate
72. Specify:
74. Describe any specialized training | Apprenticeships | Internships
76. Technology | Equipment Skills (software, machines, etc.)*
80. 4. EMPLOYMENT HISTORY - Begin with most recent first.
82. Employer 1*
83. Phone*
85. Address*
86. Dates of employment*
88. Last position held*
89. Supervisor's Name*
91. Responsibilities*
93. Reason for leaving*
95. Employer 2
96. Phone
98. Address
99. Dates of employment
101. Last position held
102. Supervisor's name
104. Responsibilities
106. Reason for leaving
108. Employer 3
109. Phone
111. Address
112. Dates of employment
114. Last position held
115. Supervisor's name
117. Responsibilities
119. Reason for leaving
121. Employer 4
122. Phone
124. Address
125. Dates of employment
127. Last position held
128. Supervisor's name
130. Responsibilities
132. Reason for leaving
134. Employer 5
135. Phone
137. Address
138. Dates of employment
140. Last position held
141. Supervisor's name
143. Responsibilities
145. Reason for Leaving
147. Employer 6
148. Phone
150. Address
151. Dates of employment
153. Last position held
154. Supervisor's name
156. Responsibilities
158. Reason for leaving
160. Employer 7
161. Phone
163. Address
164. Dates of employment
166. Last position held
167. Supervisors name
169. Responsibilities
171. Reasons for leaving
173. 5. REFERENCES (List three professional or others not related to you)
175. Name*
176. Association*
177. Phone*
179. Name*
180. Association*
181. Phone*
183. Name*
184. Association*
185. Phone*
187. ATTACHMENTS
     Attach only ONE PDF per upload field. You may combine all required attachments into one PDF or upload components separately, below.
189. 6a. Cover Letter

     PDF format only, please.

191. (OR create cover letter here:)
193. 6b. Resume*

     PDF format only.

194. 6c. Other (license, certification, etc.)

     PDF format only.

196. 6d. Other

     PDF format only.

197. 6e. Other

     PDF format only.

199. 6f. Other

     PDF format only.

200. 6g. Other

     PDF format only.

202. 7. STATEMENT OF AFFIRMATION *
204. By entering my name and date below I hereby affirm that the information I have provided on this application is true and accurate to the best of my knowledge. I authorize the verification of any or all of the information I have provided and any inquiries permissible by law to determine my suitability for employment. I understand that omissions or misrepresentations may be cause for rejection or, if I am hired, may be just cause for immediate dismissal.
206. Applicant's Signature*
207. Date*
209. The Town of Colchester is an Equal Opportunity Employer. It is the policy of the Town to provide equal employment opportunity to all applicants and employees without regard to race, color, religion, gender or sexual orientation, age, or any other status protected by state or federal law.
Leave This Blank:


211. 1. Receive an email copy of this form.
212. Email address

     This field is not part of the form submission.

213. Submit Submit and Print

* indicates a required field