Cheshire County Department of Corrections

 

825 Marlboro Road

Keene, NH 03431 

 

 

An equal opportunity employer

 

ON-LINE EMPLOYMENT APPLICATION

 

     Today's date   

                             mm/dd/yyyy

 

Personal

 

 

 

     Last name                              First name                       Middle 

         

 

     Address                                 City/town                         State        Zip Code

             

 

     Social Security number          Home Phone                      Business Phone

                 

 

     Email Address  

 

 

 

Employment History

 

     Have you been previously employed by Cheshire County?    Yes    No

 

     If Yes, when and where  

 

     Position applied for                Full time    Part time    Temp

 

     Are you available to work rotating shifts?                          

 

    Are you eligible for employment in the United States?         

    

    Are you 21 years of age?   

 

 

Education

 

    College                  Degree 

 

    High School           Diploma        G.E.D 

 

    

    Special training, skills, certifications, licenses, languages

  

 

    

Employment History

Beginning with current position

 

     Company Name                          Address                                                       Phone number

           

 

    Employment Dates                                Starting Pay               Ending Pay

    From              

    To      

 

    Name of Supervisor                      Reason for leaving

         

 

    

 

    Company Name                           Address                                                         Phone number

           

 

    Employment Dates                                   Starting Pay                Ending Pay

    From                  

    To      

 

     Name of Supervisor                        Reason for leaving

           

 

      

     Company Name                            Address                                                      Phone number

           

 

    Employment Dates                                   Starting Pay               Ending Pay

    From                  

    To      

 

    Name of Supervisor                           Reason for leaving

           

 

    Military

                                                                                      Complete if you have ever been in the armed forces

 

   

    Branch        Period of active duty     From    To 

 

    Rank at discharge                       Type of discharge 

 

    Date of discharge       Duties in brief 

 

    May we contact the employers listed above?    Yes    No         

 

    If, No  please explain            

  

 

 

    Personal References

 

 

     Name                                          Address                                                 Phone                      Occupation

            

 

 

 

     Name                                          Address                                                 Phone                      Occupation

           

 

 

     Name                                          Address                                                 Phone                      Occupation

            

 

 

 I declare the information in this employment application provided by me is true, correct, and complete to the best of my knowledge.  I understand that if employed any misstatement or omission of facts in this application shall be considered cause for dismissal.  I authorize the Cheshire County Department of Corrections to make appropriate reference, financial, and or criminal checks for verification of given information.

 

 

 

I also am aware that this application is going to the Cheshire County Dept. of Corrections in New Hampshire.

 

 

 

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