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2. Job Information
4. Job Applied For
6. What type of employment are you seeking

   1. Full-time

   1. Part-time

   1. Seasonal
8. When can you start work?
9. How did you hear about this job?
13. Applicant Information
15. Last Name
16. First Name
17. Middle Name
19. Telephone Number
20. ext.
21. Email Address
23. Current Street Address
25. City
26. State
27. Zip Code
29. Are you 18 years of age or older?*

    1. Yes
    2. No

31. *If hired, you may be required to submit proof of age.

33. Have you previously applied for a Town of Berthoud Job?

    1. Yes

    1. No
34. If yes, when?
    If yes, when?
36. Do you have any relatives employed by the Town of Berthoud?

    1. Yes

    1. No
38. Have you ever been convicted of crime? Include any plea of "guilty" or "no contest" (Exclude minor traffic violations.)

    1. Yes

    1. No
40. If yes, give details. (A conviction will not necessarily disqualify an applicant for employment.)
42. If employed do you expect to be engaged in any additional business or employment outside of our job?

    1. Yes

    1. No
44. If yes, give details.
46. For driving jobs only: Do you have a valid driver's license?

    1. Yes

    1. No
48. For driving jobs only: Have you had your driver's license suspended or revoked in the last 3 years?

    1. Yes

    1. No
50. If yes, give details
52. List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability, genetic information or other protected status.)
56. Education
58. High School or GED
59. Number of Years Completed
61. Diploma / Degree / Certificate
62. Subjects Studied
66. College or University
67. Numbers of Years Completed
69. Diploma / Degree / Certificate
70. Subjects Studied
74. Vocational or Technical
75. Number of Years Completed
77. Diploma / Degree / Certificate
78. Subjects Studied
82. What skills or additional training do you have that relate to the job for which you are applying?
84. What machines or equipment can you operate that relate to the job for which you are applying?
88. Work History

    List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give business name and supply business references.

    Note: A job offer may be contingent upon acceptable references from current and former employers.

90. Name of Employer
91. Job Title
93. Summary of Duties
95. Address
96. City
98. State
99. Zip Code
101. Telephone Number
102. Extension
104. Date of Employment From
     Date of Employment From
105. Date of Employment To
     Date of Employment To
107. Reason for Leaving
108. Supervisor(s)
112. Name of Employer
113. Job Title
115. Summary of Duties
117. Address
118. City
120. State
121. Zip Code
123. Telephone Number
124. Extension
126. Date of Employment From
     Date of Employment From
127. Date of Employment To
     Date of Employment To
129. Reason for Leaving
130. Supervisor(s)
134. Name of Employer
135. Job Title
137. Summary Duties
139. Address
140. City
142. State
143. Zip Code
145. Telephone Number
146. Extension
148. Date of Employment From
     Date of Employment From
149. Date of Employment To
     Date of Employment To
151. Reason for Leaving
152. Supervisor(s)
156. Name of Employer
157. Job Title
159. Summary of Duties
161. Address
162. City
164. State
165. Zip Code
167. Telephone Number
168. Extension
170. Date of Employment From
     Date of Employment From
171. Date of Employment To
     Date of Employment To
173. Reason for Leaving
174. Supervisor(s)
178. Additional Questions
180. Have you worked or attended school under any other names:

     1. Yes

     1. No
182. If yes, give names.
184. Are you presently employed?

     1. Yes

     1. No
186. If yes, who can we contact?
188. Name
189. Telephone Number
190. Extension
192. Have you ever been terminated or asked to resign from a job?

     1. Yes
     2. No
196. References
198. Name
200. Address
202. City
203. State
204. Zip Code
206. Telephone Number
207. Extension
208. Relationship
212. Name
214. Address
216. City
217. State
218. Zip Code
220. Telephone Number
221. Extension
222. Relationship
226. Name
228. Address
230. City
231. State
232. Zip Code
234. Telephone Number
235. Extension
236. Relationship
240. Please Read Each Statement Carefully Before Signing

     I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I may be required to successfully pass a drug screening examination. I hereby consent to possible drug screening as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination if required for the position. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. 

     I understand that this application, verbal statements by management, or subsequent employment does not create an express or implied contract of employment nor guarantee employment for any definite period of time. Only the president of the organization has the authority to enter into an agreement of employment for any specified period and such agreement must be in writing, signed by the president and the employee. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without reason and with or without notice. 

     If hired, you will be required to furnish proof of your eligibility to work in the United States.

     I have read, understand, and by my signature consent to these statements. 

     By typing your name and submitting this application You agree to the above statement.

242. Submitted applications must be complete for consideration. Incomplete job applications will be excluded from selection process.
244. Type your name here (This is your signature for the application):
245. Today's Date
     Today's Date
247. Additional Information

     Occasionally the format of an employment application makes it difficult for an applicant to adequately summarize work history and education. Please upload any additional application documents below. (This area is not required.)

249. Upload Cover Letter

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251. Upload Resume

     Maximum size allowed: 5 MB
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253. Upload Supporting Documents

     Maximum size allowed: 5 MB
     Allowed types: .gif,.jpg,.jpeg,.png,.doc,.docx,.xls,.xlsx,.rtf,.pdf,.txt

255. Upload Supporting Documents

     Maximum size allowed: 5 MB
     Allowed types: .gif,.jpg,.jpeg,.png,.doc,.docx,.xls,.xlsx,.rtf,.pdf,.txt

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257. 1. Receive an email copy of this form.
258. Email address

     This field is not part of the form submission.

259. Submit

* indicates a required field