Application for Employment (Online)

Date *

Personal Information

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone *

Cell Phone *

Email *

Are you legally eligible to work in the United States? *

(Proof of citizenship or immigration status will be required upon employment)

If under 18 years of age, can you provide proof of eligibility to work? *

Employment Desired

Position Applying For: *

Date Available to Start: *

Are you available to work (check all that apply): *

Select All
Full Time
Part Time
Evenings/Weekends
Temporary/Seasonal

Are you able to work overtime on evenings, weekends, and holidays if necessary? *

How did you hear about the position?

Have you ever been an employee of the City of Holyoke? *

If yes, please give dates:

(MM/DD/YYY to MM/DD/YYYY)

In which department?

What position?

Employment Experience

Please start with your present or last job. Include any job-related military and/or volunteer assignments. This section must be completed in full.

1. Employer Name: *

Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone *

Supervisor

First Last

Dates employed: *

(MM/YYYY to MM/YYYY)

Job Title: *

Reason for leaving or seeking other employment:

May we contact this employer? *

2. Employer Name: *

Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone *

Supervisor

First Last

Dates employed: *

(MM/YYYY to MM/YYYY)

Job Title: *

Reason for leaving or seeking other employment:

May we contact this employer? *

3. Employer Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Supervisor

First Last

Dates employed:

(MM/YYYY to MM/YYYY)

Job Title:

Reason for leaving or seeking other employment:

May we contact this employer?

Education/Skills

Education *

Name and Location	Years Attended	Degree Earned

Military service and status:

Branch of service:	Military occupation specialty:	Length of active duty (MM/YYYY to MM/YYYY):	Rank at time of separation:

Do you claim Veterans Preference?

Yes
No

Please select the skills that are relevant to the position desired:

Microsoft Word
Microsoft Excel
Microsoft PowerPoint
Microsoft Access

Typing speed (words per min.)

Licenses

Do you have a valid driver’s license? *

Yes
No

Expiration date:

(MM/DD/YYYY)

Have you ever had your license or driving privileges revoked, suspended, or placed on probation? *

Yes
No

If Yes, please explain. Include when, where and what action was taken: Do not list losses of licenses resulting from convictions of misdemeanors within the last 5 years or resulting from first convictions of simple assault, drunkenness, speeding, minor traffic violations, affray, or disturbance of the peace.

List only licenses, certifications and professional designations relevant to the requirements of the position for which you are applying):

Certification Type	Issuing Authority	Issue Date (mm/dd/yyyy)	Expiration Date (mm/dd/yyyy)

References

Please list (3) three professional and/or business references who can comment on your past job performance:

Full Name:	Relationship:	Company:	Phone:

Disclosure of names of family members who are City of Holyoke Employees:

Is any immediate family member an employee of the City of Holyoke? Immediate family member is defined as your spouse, parent, brother, sister or child, or the spouse of your parent, brother, sister or child? *

Yes
No

If you answered Yes, please list below the name(s) of any City of Holyoke employee who is your spouse, parent, brother, sister or child, or who is the spouse of your parent, brother, sister or child, and indicate their relationship to you. Please also list the name of the department that employs those relatives.

Name of Relative	Department	Relationship

City policy prohibits the hiring of applicants that would lead, or may lead to a conflict of interest with an immediate family member. No supervisory employee of the City of Holyoke shall be involved in the hiring, termination, reappointment, promotion, reclassification, demotion, firing, or other personnel decisions of an immediate family member. No employee shall participate in a job performance evaluation of an immediate family member. An employee of the City of Holyoke is prohibited not only from participating in personnel decisions affecting his or her immediate family members, but also from delegating the authority to a subordinate. The signing of warrants authorizing payroll or other payments to immediate family members is prohibited. Note: For purposes of this disclosure, an “employee” is a person holding a paid or unpaid office, position, employment, or membership in any City of Holyoke department, board, or commission. For purposes of this disclosure, a “department” shall include any entity operating as part of the government of the City of Holyoke, and all councils thereof and there under, and any division, board or commission.

Resume & Cover Letter

Please submit your resume and cover letter in PDF format. *

Max. file size: 25 MB.

Voluntary Affirmative Action Request

The City of Holyoke, as part of its commitment to Affirmative Action/Equal Employment Opportunity policies, invites you to provide the following information. The information is voluntary and refusal to provide it will not have any bearing on our employment decision. The data is confidential and will be filed separately. It will be available only to authorized personnel and is used to further the City’s Affirmative Action/Equal Employment Opportunity policies. Your cooperation is appreciated.

Gender

Male
Female
Non-Binary

Ethnic Origin

White (Not Hispanic or Latino)
Black (Not Hispanic or Latino)
Hispanic
Asian or Pacific Islander
American Indian or Alaskan Native
Other

Veteran Status

Veteran
Disabled Veteran
Vietnam Era

Consent

I agree to the Applicant's Statement.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

I acknowledge that the information provided in this application for employment is true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.

I authorize investigation of all statements contained in this application and the release of any pertinent information regarding my education, past employment history and background. I authorize the City of Holyoke to obtain any information from schools, employers, or individuals relating to my activities. This information may include, but is not limited to academics, achievement, performance, attendance, personal history, and discipline. Further, I hereby authorize all references, persons, schools, my current employer (if applicable) and previous employers and organizations named in this application, unless otherwise stated, to provide the City of Holyoke any relevant information that may be required to arrive at an employment decision. I understand that the information released is for the City of Holyoke's use only.

I hereby voluntarily release, discharge, and exonerate the City of Holyoke, its agents and representatives, and any person so furnishing information from any and all liabilities of every nature and kind arising out of the furnishing or inspection of such documents, records and other information or the investigations made by or on behalf of the City of Holyoke.

I understand that all appointments are probationary and that I must demonstrate my ability for continued employment. I also understand that I must be available from time to time to work outside normal business hours, as the needs of the department require. In the event of my employment with the City of Holyoke, I will comply with all rules, regulations, and policies distributed by the City of Holyoke.

I agree to sign a Criminal Offender Record Information Release form and further authorize the City of Holyoke to conduct background checks that they deem necessary for evaluating my application for employment, and to obtain a report from a consumer-reporting agency to be used for employment purposes in accordance with the Fair Credit Reporting Act. If required for the position I am seeking, I agree to take a physical examination, which may include testing for drugs or a psychological examination, as required, and recognize that any offer of employment may be contingent upon the results of such an examination.

I understand that any employment offer by the City is conditional upon my ability to establish employment eligibility under the Immigration Reform and Control Act of 1986 within three days of the date of hire.

I understand that employment with the City of Holyoke is "at will" which means that either the City or I may terminate the employment relationship at any time, with or without prior notice, and for any reason except as prohibited by law or agreement. I understand that no supervisor, manager, or executive of the City of Holyoke has any authority to alter the foregoing.

I understand that if an offer of employment is made to me, the City of Holyoke may specify that it is contingent upon the results of a medical exam. I freely and voluntarily agree to submit to a pre-employment physical and/or drug screen, as it relates to the requirements of a specific job, as part of my pre-employment application to the City of Holyoke. I understand that either refusal to submit to such screening or failure to qualify according to the minimum standards established by the City of Holyoke for this screening may disqualify me from further consideration for employment. Further, I understand that any positive drug test results will be communicated in a confidential manner.

Documents and forms

Application for Employment (Online)

Personal Information

Employment Desired

Employment Experience

Education/Skills

Licenses

References

Disclosure of names of family members who are City of Holyoke Employees:

Resume & Cover Letter

Voluntary Affirmative Action Request