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TOWN OF PURCELLVILLE

  1. APPLICATION FOR EMPLOYMENT

  2. AN EQUAL OPPORTUNITY EMPLOYER: Under the provision of the Americans with Disability Act (ADA) reasonable accommodation will be made during the selection process for this job upon your request. The Town of Purcellville considers all applicants without regard to gender, race, religion, color, creed, age, disability, national origin, marital or veteran status, or any other legally protected status.

  3. If under the age of 18, can you provide the required proof of your eligibility to work?*

  4. For the purpose of compliance with the United States Immigration and Nationalization Act, and Section 40.1-11.1 of the Code of Virginia, are you legally eligible for employment in the United States? Proof of Citizenship or immigration status will be required upon employment.*

  5. Have you ever filled out an application with the Town of Purcellville before?*

  6. Have you ever been employed with the Town of Purcellville before?*

  7. Are you currently employed?*

  8. May we contact your current employer?*

  9. Have you ever been fired or resigned from a position after being notified you were fired?*

  10. Interested in:*

  11. Do you have a valid Drivers License?*

  12. Can you travel if the job requires it?*

  13. Are you currently on "lay off" status and subject to recall?*

  14. EDUCATION

    Please list all types that apply.

  15. Add another School

  16. Add another School

  17. Add another School

  18. WORK EXPERIENCE

    Please list your current or last employer first, including related military service or volunteer work.

  19. Add another Employer

  20. Add another Employer

  21. Add another Employer

  22. (You may exclude membership that would reveal gender, race, religion, national origin, age, ancestry or other protected status)

  23. Office/Computer Skills (check all that apply)

  24. REFERENCES

    Personal or Professional References (please do not include family members or past supervisors)

  25. APPLICANT'S STATEMENT

    Please read carefully before signing

  26. I certify that the statements in this application are true and complete to the best of my knowledge, and I agree that any intentional misstatement or omission will constitute ground for unfavorable consideration of my application or dismissal from employment with the Town of Purcellville.

  27. I authorize the Town of Purcellville to obtain information from past employers and other sources to support the data on this application, including a review of my educational, criminal and credit records, as appropriate.

  28. This employment application shall be considered active for a period to time not to exceed 45 days. Applicants wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

  29. I understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the town of Purcellville is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. I further understand that this “at will” relationship with my employer may not be changed by any written document or by conduct unless an authorized executive of the Town of Purcellville specifically acknowledges such a change in writing.

  30. I understand that I am required to abide by all rules and regulations of the employer.

  31. By entering my signature and initials above I authorize this digital signature to be used as my signature

  32. Leave This Blank:

  33. This field is not part of the form submission.