Typist-Clerk I, Bilingual-Spanish (Provisional)

First name*

Last name*

Email address*

Location *

Phone number*

Resume*

Previous Employer 1: Name, Address and dates of employment. (If never worked, state N/A)*

List duties and responsibilities*

Previous Employer 2: Name, Address and dates of employment. (If never worked, state N/A)*

List duties and responsibilities:*

Previous Employer 3: Name, Address and dates of employment. (If never worked, state N/A)*

List duties and responsibilities*

List any special skills, qualifications, or experience relevant to the position for which you are applying.

Were you ever employed by the Village of Hempstead? If yes, state dates and department.*

Are there any arrests currently pending against you? If yes, please explain:*

Do you have relatives working for the Village? If yes, state name and department:*

I hereby certify that the information provided in this Application for Employment is true, correct and complete. Any misstatement or omission of fact on this application may result in the rejection of my application or in my termination, if employed by the Inc. Village of Hempstead.

I understand that acceptance of an offer of employment does not create a contractual obligation upon the Inc. Village of Hempstead to continue to employ me in the future.

I authorize the Inc. Village of Hempstead to contact any educational institutions, former employers, or other individuals and entities having information concerning me to make inquiries and obtain information, including personnel files, relevant to my background, performance, and abilities as an employee or relating to my application for employment. I hereby release all such entities and individuals from any and all claims, including but not limited to clams of defamation, associated with the release or disclosure of such information to the Inc. Village of Hempstead.

I agree that a copy of this authorization and release maybe accepted with the same authority as the original.*

Enter Name*

Date*

Human Check*