Submit an application for employment Please enable JavaScript in your browser to complete this form. Please enable JavaScript in your browser to complete this form. Personal Information Name * First Middle Last Address * Address Line 1 Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState Zip Code Phone Email * Email Confirm Email Are you 18 years of age or older? * YesNo Are you legally eligible to work in the United States? * YesNo Have you ever previously been employed by this Town? * YesNo If yes, When? (previously employed) Do you now or have you ever had a relative employed by this Town? * YesNo If yes, who? (relative employed) Have you ever been arrested or convicted of a crime that has not been expunged by a court? * YesNo If yes, please explain. (arrest or conviction) the – – *Candidates selected for probable employment who are age 18 or older may be required to consent to a background check as a condition of employment. * Acknowledge Employment Desired Position Desired * Fire Department -Full-Time Firefighter/ParamedicFire Department – Firefighter/EMT & Firefighter/ParamedicFire Department – Part-Time Firefighter/EMT & Firefighter/ParamedicTown Manager This form can not be used for applications for the Police Department. Applications for a position with the Police Department must utilize the appropriate application included with the job posting. This position requires the following in your application process: This Application Cover Letter Resume You will be able to upload supporting documentation as you near the completion of the application. Date Available to Work * Status Desired * Full-timePart-time Desired Hourly Rate/Base Salary Are you available to work: Weekday/daytime hours? * YesNo Weekday/evening hours? * YesNo Saturday? * YesNo Sunday afternoon? * YesNo Are you currently employed? * YesNo May we contact your present employer? * YesNo Educational Information Check any that apply * High School College or University Other (Technical/Trade School, Business School/Other N/A High School – Name and Location of School High School – Number of Years Attended College or University – Name and Location of School College or University – Number of Years Attended College or University – Degree Received College or University – Subjects Studied/Major Other (Technical/Trade School, Business School/Other – Name and Location of School Other (Technical/Trade School, Business School/Other – Number of Years Attended Other (Technical/Trade School, Business School/Other – Degree Received Other (Technical/Trade School, Business School/Other – Subjects Studied/Major Employment History Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. If needed, you can use the paragraph text at the end of this section. Incomplete information could disqualify you from further consideration. 1 – From and To Date: Month and Year 1 – Employer’s Name 1 – Employer’s Address 1 – Position/Title 1 – Status Full-timePart-time 1 – Briefly Describe Duties 1 – Reason for Leaving 1 – Rate of Pay 1 – Supervisor’s Name/Title Add Additional Employment Yes 2 – From and To Date: Month and Year 2 – Employer’s Name 2 – Employer’s Address 2 – Position/Title 2 – Status Full-timePart-time 2 – Briefly Describe Duties 2 – Reason for Leaving 2 – Rate of Pay 2 – Supervisor’s Name/Title Add Additional Employment (2) Yes 3 – From and To Date: Month and Year 3 – Employer’s Name 3 – Employer’s Address 3 – Position/Title 3 – Status Full-timePart-time 3 – Briefly Describe Duties 3 – Reason for Leaving 3 – Rate of Pay 3 – Supervisor’s Name/Title Add Additional Employment (3) Yes Additional Employment Please include Additional Employers, Addresses, Dutes, Pay Rate, and reason for leaving. Other Skills/Memberships and Affiliations Do you have any special skills, volunteer experience and/or training that would enhance your ability to perform the position applied for? * YesNo Please explain: (volunteer/experience) Do you hold a license or professional certification? * YesNo Please specify: (certification) Do you participate in any professional associations that would enhance your ability to perform the position applied for? * YesNo Please explain: (associations) References Please give the names of three persons not related to you, and preferably who you have worked with/for and whom you have known at least 3 years. Name – Reference 1 * First Last Address/Phone/Email – Reference 1 Company Name – Reference 1 Years Know – Reference 1 Name – Reference 2 * First Last Address/Phone/Email – Reference 2 Company Name – Reference 2 Years Know – Reference 2 Name – Reference 3 * First Last Address/Phone/Email – Reference 3 Company Name – Reference 3 Years Know – Reference 3 File Upload Click or drag files to this area to upload. You can upload up to 3 files. Please include if necessary, your resume, cover page, and additional documentation. Please read carefully before signing. The Town of Cedar Lake is an equal opportunity employer. The Town of Cedar Lake does not discriminate in employment on account of race, color, religion, sex (pregnancy, gender identity, and sexual orientation), national origin, age (40 and over), disability, genetic information as referenced in the Genetic Information Nondiscrimination Act (GINA), military service veteran status or any other protected class as defined by federal, state, and local laws. The Town of Cedar Lake will comply with its obligation to provide reasonable accommodation to qualified individuals with disabilities. I understand that neither the completion of this application nor any other part of my consideration for employment establishes an obligation for the Town of Cedar Lake to hire me. If I am hired, I understand that either the Town of Cedar Lake or I may terminate employment at any time for any reason, with or without cause and without prior notice. I understand that no representative of the Town of Cedar Lake has the authority to make any assurance to the contrary. In addition, I understand that the Town of Cedar Lake utilizes the national E-Verify system to confirm my employment eligibility. I attest with my signature below that I have given to the Town of Cedar Lake true and complete information on this application. No requested information has been concealed. I authorize the Town of Cedar Lake to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for denial of employment or immediate dismissal. Signature * Clear Signature Date Signed * Note Applications for employment will be kept on file for three-years from the date of completion. Submit
