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Election Worker Application

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Steps

1. Personal Information(current) This section is complete This section is incomplete
2. Position Information This section is complete This section is incomplete
3. Education This section is complete This section is incomplete
4. Employment History This section is complete This section is incomplete
5. References This section is complete This section is incomplete
6. Disclaimer & Signature This section is complete This section is incomplete

Personal Information

First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address
Cell Phone
Work Phone
Are you a U.S. citizen or authorized to work in the U.S.?*
1. Yes
1. No
When will you be able to begin work?
Are you eligible to work in the United States?*
1. Yes
1. No
Upload Your Resume
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Position Information

Which position are you applying for?*
Type of employment desired*
1. Full Time
1. Part Time
1. Internship
Saraly desired*
Hours of work (per week) desired*
How did you hear about the position?*
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Education

High School
Address
College
Address
Degree
Other
Address
Degree
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Employment History

(From Most Recent)
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Salary
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References

Please list three professional references.
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
Full Name*
Relationship*
Company*
Phone Number*
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Disclaimer & Signature

I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*

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95 Pleasant Street
Gardner, MA 01440
Phone: 978-632-1900
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