Submit an Application for Employment

Personal Information

Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Confirm Email

Are you 18 years of age or older?

Are you legally eligible to work in the United States?

Have you ever previously been employed by this Town?

If yes, When? (previously employed)

Do you now or have you ever had a relative employed by this Town?

If yes, who? (relative employed)

Have you ever been arrested or convicted of a crime that has not been expunged by a court?

If yes, please explain. (arrest or conviction)

*Candidates selected for probable employment who are age 18 or older may be required to consent to a background check as a condition of employment.

Acknowledge

Employment Desired

Position Desired

This form can not be used for applications for the Police Department. Applications for a position with the Police Department must utilize the appropriate application included with the job posting.

This position requires the following Minimum Requirements:

State of Indiana/Nationally Accredited EMT
State of Indiana Firefighter II
Valid State of Indiana Driver’s License
High School Diploma or equivalent

Date Available to Work

Status Desired

Desired Hourly Rate/Base Salary

Are you available to work:

Weekday/daytime hours?

Weekday/evening hours?

Saturday?

Sunday afternoon?

Are you currently employed?

May we contact your present employer?

Educational Information

Check any that apply

High School
College or University
Other (Technical/Trade School, Business School/Other
N/A

High School – Name and Location of School

High School – Number of Years Attended

College or University – Name and Location of School

College or University – Number of Years Attended

College or University – Degree Received

College or University – Subjects Studied/Major

Other (Technical/Trade School, Business School/Other – Name and Location of School

Other (Technical/Trade School, Business School/Other – Number of Years Attended

Other (Technical/Trade School, Business School/Other – Degree Received

Other (Technical/Trade School, Business School/Other – Subjects Studied/Major

Employment History

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. If needed, you can use the paragraph text at the end of this section. Incomplete information could disqualify you from further consideration.

1 – From and To Date:

Month and Year

1 – Employer’s Name

1 – Employer’s Address

1 – Position/Title

1 – Status

1 – Briefly Describe Duties

1 – Reason for Leaving

1 – Rate of Pay

1 – Supervisor’s Name/Title

Add Additional Employment

Yes

2 – From and To Date:

Month and Year

2 – Employer’s Name

2 – Employer’s Address

perform Salary expunged

2 – Position/Title

2 – Status

2 – Briefly Describe Duties

2 – Reason for Leaving

2 – Rate of Pay

2 – Supervisor’s Name/Title

Add Additional Employment (2)

Yes

3 – From and To Date:

Month and Year

3 – Employer’s Name

3 – Employer’s Address

3 – Position/Title

3 – Status

3 – Briefly Describe Duties

3 – Reason for Leaving

3 – Rate of Pay

3 – Supervisor’s Name/Title

Add Additional Employment (3)

Yes

Additional Employment

Please include Additional Employers, Addresses, Dutes, Pay Rate, and reason for leaving.

Other Skills/Memberships and Affiliations

Do you have any special skills, volunteer experience and/or training that would enhance your ability to perform the position applied for?

Please explain: (volunteer/experience)

Do you hold a license or professional certification?

Please specify: (certification)

Do you participate in any professional associations that would enhance your ability to perform the position applied for?

Please explain: (associations)

References

Please give the names of three persons not related to you, and preferably who you have worked with/for and whom you have known at least 3 years.

Name – Reference 1

First

Last

Address/Phone/Email – Reference 1

Company Name – Reference 1

Years Know – Reference 1

Name – Reference 2

First

Last

Address/Phone/Email – Reference 2

Company Name – Reference 2

Years Know – Reference 2

Name – Reference 3

First

Last

Address/Phone/Email – Reference 3

Company Name – Reference 3

Years Know – Reference 3

File Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

Please include if necessary, your resume, cover page, and additional documentation.

Please read carefully before signing.

The Town of Cedar Lake is an equal opportunity employer. The Town of Cedar Lake does not discriminate in employment on account of race, color, religion, sex (pregnancy, gender identity, and sexual orientation), national origin, age (40 and over), disability, genetic information as referenced in the Genetic Information Nondiscrimination Act (GINA), military service veteran status or any other protected class as defined by federal, state, and local laws. The Town of Cedar Lake will comply with its obligation to provide reasonable accommodation to qualified individuals with disabilities.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes an obligation for the Town of Cedar Lake to hire me. If I am hired, I understand that either the Town of Cedar Lake or I may terminate employment at any time for any reason, with or without cause and without prior notice. I understand that no representative of the Town of Cedar Lake has the authority to make any assurance to the contrary. In addition, I understand that the Town of Cedar Lake utilizes the national E-Verify system to confirm my employment eligibility.

I attest with my signature below that I have given to the Town of Cedar Lake true and complete information on this application. No requested information has been concealed. I authorize the Town of Cedar Lake to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for denial of employment or immediate dismissal.

Signature

Clear Signature

Date Signed

Note

Applications for employment will be kept on file for three-years from the date of completion.