Fillable Printable NH EMPLOYMENT APPLICATION FOR CITY OF MANCHESTER
Fillable Printable NH EMPLOYMENT APPLICATION FOR CITY OF MANCHESTER
NH EMPLOYMENT APPLICATION FOR CITY OF MANCHESTER
CITY OF MANCHESTER, NH
EMPLOYMENT APPLICATION
Submit Application To:
HUMAN RESOURCES DEPARTMENT
ONE CITY HALL PLAZA
MANCHESTER, NH 03101-4000
Tel: (603) 624-6543 TTY/Voice
Fax: (603) 628- 6065
All information provided by applicants for employment on this application form may be verified for accuracy. Inaccu-
rate information may be grounds for disqualification for, or dismissal from, employment. We offer equal employment
opportunity to all persons without regard to race, color, religion, age, gender, national origin, disability, sexual orienta-
tion, marital or veteran's status or any other legally protected status.
______________________________________________________________________________________________________
NAME:________________________________________________ _____________ DATE : ________________________________
ADDRESS: _________________________________________________________ PHONE: ______ _________________________
CITY/STATE: _________________________________ _ ZIP: _____________ EMAIL: _____________________ __________
Position Title: __________________ _____________________ _______ Full-time _____ Part-ti me _____ Tempo rary/Seasonal _____
Are you a US citizen? Yes___ No ___ If not, do you have the legal right to work in the US? Yes ___ No ___ (Visa type________)
Are you at least 18 years of ag e? Yes___ No ___
Have you ever worked for the City of Manchester? Yes ___ No ___ If yes, When? ____________________
What Department? ____________________________________ Supervisor ___________________________________
Are you curren tly employed? Yes ___ No ___ If employed, wh y do you wish to change positions?
________________________________________________________________________________________________________________
Provide additional information such as special skills, equipment operation, languages, supervisory experience, train-
ing or other qualifications helpful to us in considering you for this position.
____________________________________________________________________________________________________________
________________________________________________________________________________________________________________
List volunteer experience you have as it relates to this position.
Agency Name ____________________________________ From _______________ To ________________
Address _________________________________________ Hours per week ___________________________
Duties ______________________________________________________________________________________
______________________________________________________________________________________________
Have you ever been convicted of any violation of the law (misdemeanor or felony) that has not been officially
annulled? Yes _____ No _____ If yes, state date, place and nature of conviction (a conviction will not necessarily
disqualify an applicant from employment, as each case is con sidered individually) _________________________
____________________________________________________________________________________________
______________________________________________________________________________________________
Valid Motor Vehicle Operator's License? Yes _____ No _____ What State? __________________________
Do you possess a Commercial Driver's License? Yes _____ No _____ Type? ______ What State?___________
List other valid licenses, registrations or certificates you possess _______________________________________
Type of School Name/Address Course/Major Last Yr Completed Graduate? List Degree
High School 9 10 11 12
Y N
Trade/Technical 1 2 3 4
Y N
College 1 2 3 4
Y N
Post Graduate 5 6 7 8
Y N
PRIOR WORK RECORD (start with most recent or current employer and work back at least ten years). Resumes may be
attached, but not in lieu of completing this section. Incomplete employment history and/or statements such as “refer to
resume” will be cause for disqualification. If more space is needed, please complete and attach a separate page.
Application must be signed and dated on Page 3 to be considered valid and complete.
_____________________________________________________________________________________________________
Current Employer __________________________________________ Tel. # ____________ Part time ___ Full Time ___
Address ___________________________________________________ Date Hired ________ Date Left _______________
Supervisor (Name/Position) ___________________________________ Number of People You Supervise______________
Job Title ___________________________________________________ Duties ____________________________________
_____________________________________________________________________________________________________
____________________________________________________ Reason for leaving ________________________________
Previous Employer __________________________________________ Tel. # ____________ Part time ___ Full Time ___
Address ___________________________________________________ Date Hired ________ Date Left _______________
Supervisor (Name/Position) ___________________________________ Number of People You Supervise ______________
Job Title ___________________________________________________ Duties ____________________________________
_____________________________________________________________________________________________________
___________________________________________________ Reason for leaving _________________________________
Previous Employer __________________________________________ Tel. # ____________ Part time ___ Full Time ___
Address ___________________________________________________ Date Hired ________ Date Left _______________
Supervisor (Name/Position) ___________________________________ Number of People You Supervise ______________
Job Title ___________________________________________________ Duties ____________________________________
_____________________________________________________________________________________________________
___________________________________________________ Reason for leaving _________________________________
Previous Employer __________________________________________ Tel. # ____________ Part time ___ Full Time ___
Address ___________________________________________________ Date Hired ________ Date Left _______________
Supervisor (Name/Position) ___________________________________ Number of People You Supervise ______________
Job Title ___________________________________________________ Duties ____________________________________
_____________________________________________________________________________________________________
___________________________________________________ Reason for leaving _________________________________
Previous Employer __________________________________________ Tel. # ____________ Part time ___ Full Time ___
Address ___________________________________________________ Date Hired ________ Date Left _______________
Supervisor (Name/Position) ___________________________________ Number of People You Supervise ______________
Job Title ___________________________________________________ Duties ____________________________________
_____________________________________________________________________________________________________
___________________________________________________ Reason for leaving _________________________________
City of Manchester Employment Application - Page 2
PRIOR WORK RECORD (continued)
Previous Employer __________________________________________ Tel. # ____________ Part time ___ Full Time ___
Address ___________________________________________________ Date Hired ________ Date Left _______________
Supervisor (Name/Position) ___________________________________ Number of People You Supervise______________
Job Title ___________________________________________________ Duties ____________________________________
_____________________________________________________________________________________________________
____________________________________________________ Reason for leaving ________________________________
Previous Employer __________________________________________ Tel. # ____________ Part time ___ Full Time ___
Address ___________________________________________________ Date Hired ________ Date Left _______________
Supervisor (Name/Position) ___________________________________ Number of People You Supervise ______________
Job Title ___________________________________________________ Duties ____________________________________
_____________________________________________________________________________________________________
___________________________________________________ Reason for leaving _________________________________
Previous Employer __________________________________________ Tel. # ____________ Part time ___ Full Time ___
Address ___________________________________________________ Date Hired ________ Date Left _______________
Supervisor (Name/Position) ___________________________________ Number of People You Supervise ______________
Job Title ___________________________________________________ Duties ____________________________________
_____________________________________________________________________________________________________
___________________________________________________ Reason for leaving _________________________________
Have you ever been discharged or asked to resign from any job? Yes ____ No ____ Explain _________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
APPLICATION AGREEMENT AND CERTIFICATION
I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be
false in any way, it shall be considered sufficient cause for denial of employment or discharge. I understand that nothing contained in this
employment application or in the granting of an interview is intended to create an employment contract between the City of Manchester and
myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me. If an employ-
ment relationship is established, I understand that I have the right to terminate my employment at any time and that the City of Manchester
retains the same right.
I understand that prior to being offered employment with the City of Manchester, I may be requested to take pre-employment exams and/or
tests. In the event I have a disability which will affect my ability to take the test, I will so inform the City of Manchester prior to the admini-
stration of the test so that a reasonable accommodation can be made. Requested accommodations may include accessible testing sites, modi-
fied testing conditions, and accessible testing formats. The City of Manchester reserves the right to require medical documentation concern-
ing the need for the accommodation. I understand that if employed, policies and rules which are issued are not conditions of employment
and that the City of Manchester may revise policies or procedures, in whole or part, at any time.
SIGNATURE ___________________________________________________ DATE_________________
City of Manchester Employment Application - Page 3
HR DEPT. USE ONLY
REVIEWED BY:
DATE:
City of Manchester – Reference Release Form
City of Manchester
Department of Human Resources
One City Hall Plaza
Manchester, NH 03101
RELEASE FORM-EMPLOYMENT REFERENCES
Date: __________
Name: __________________________________________________________________
Address: ___________________________________________________________________
I authorize my current and/or previous employer/s to furnish the City of Manchester the information requested in the
reference check that they may conduct. I further promise to hold said current and/or previous employers, its employees
and officers harmless for any statements made herein.
Signature ____________________________________ Social Security number _________________________
Please check:
(if No, please provide explanation)
Yes I authorize the City of Manchester to contact my former employer(s) to obtain data necessary to support
this application.
No ______________________________________________________________________________
______________________________________________________________________________
Yes I authorize the City of Manchester to contact my present employer to obtain data necessary to support
this application.
No ______________________________________________________________________________
______________________________________________________________________________
Applicants for summer temporary employment, or no job experience at all, must provide the names of two personal
references whom we may contact regarding you (e.g., teachers, guidance counselors, or others):
Name ______________________________________ Name ______________________________________
Position_____________________________________ Position ____________________________________
Employed by ________________________________ Employed by ________________________________
Phone # ____________________________________ Phone # _____________________________________
City of Manchester
Human Resourc es Department
One City Hall Plaza
Manchester, New Hampshire 03101
Tel: (603) 624-6543
Fax: (603) 628-6065
City of Manchester – EEO Supplem ent Form
JOB APPLICATION SUPPLEMENT
(voluntary)
The following information is being gathered by the City of Manchester, NH, Human Resources
Department for Equal Employment Opportunity reporting requirements. The statistical information
we obtain through the use of this form is valuable to us and will remain confidential. This
information will not be sent with your application to a City Department at any tim e during the hiring
process.
The City of Manchester, NH, does not discriminate on the basis of age, race, color, creed, religion,
gender, national origin, sexual orientat ion, disability or marital status.
PLEASE RESPOND TO THE FOLLOWING QUESTIONS:
1. Sex Male Female
2. Date of Birth: __________________
Month/Day/Year
3. List the position for which you are applying: _________________________________________
4. Racial/ethnic data: Please identify yourself in terms of the racial/ethnic groups listed below by
checking the appropriate box:
Black American Indian or Alaskan Native
Hispanic Asian or Pacific Island
White Other (Specific) _________________________
5. How did you hear about this job? _________________________________________________
6. If you saw this position advertised, tell us where you saw the ad: ________________________
7. Name: _______________________________________________________________________
Address: _____________________________________________________________________
Street City, State zip
Phone: _____________________________ Date: ______________________
