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Application for Employment

2. Thank you for your interest in employment with the City of Westbrook.
4. General Information and Instructions
   1. All items on the application form must be filled out or marked "NA" meaning they do not apply to the applicant. Failure to fully complete this form may result in automatic disqualification. Assistance is available upon request to help complete the application.
   2. The City of Westbrook is an Equal Opportunity Employer and shall not discriminate against an employee or applicant for employment or advancement because of race, color, sex, marital status, physical or mental disability, religion, age, ancestry, national origin, sexual orientation or any other basis protected by statute.
   3. The City Of Westbrook shall employ the best qualified persons who are available at the salary levels established for City employment.
   4. Upon appointment, all employees shall be subject to a period of 6 months probation unless otherwise specified by the Personnel Rules and Regulations or applicable union contract.
   5. Applications will be kept active for a period of 1 year, during which they may be reconsidered for existing vacancies, upon request of the applicant.
   6. Please return the signed application with any supplemental material in person, by mail or email to:
   Westbrook City Hall
   Attention: Office of Human Resources
   2 York Street
   Westbrook, ME 04092
   Email Human Resources
6. Policy Prohibiting Discrimination
   It is the City's policy to comply with all applicable federal and state laws prohibiting discrimination in employment based on race, color, sex, manta/ status, physical or mental disability, religion, age, ancestry, national origin, sexual orientation or any other basis protected by statute.
10. Personal Information
12. Name
13. Email
15. Street Address
17. City
18. State
19. Zip
21. Phone
22. Alternate Phone
24. Do you have any relatives currently working for the City of Westbrook?

    1. Yes

    1. No
26. Are you authorized to work in the United States on an unrestricted basis?

    1. Yes

    1. No
28. Are you at least 18 years of age?

    1. Yes

    1. No
30. Have you ever applied for employment or worked here before?

    1. Yes

    1. No
32. If yes to either, please give details.
34. Have you been told the essential functions of the job or have you been shown a copy of the job description listing the essential functions of the job?

    1. Yes

    1. No
36. Can you perform these essential functions with or without reasonable accommodations?

    1. Yes

    1. No
38. Position Applied For
39. When Can You Start
43. Education
45. Institution: High School
47. Name and Location of School
49. Year Graduated
50. Major
52. Diploma/Degree
56. Institution: College/University
58. Name and Location of School
60. Year Graduated
61. Major
63. Diploma/Degree
67. Institution: College/University
69. Name and Location of School
71. Year Graduated
72. Major
74. Diploma/Degree
78. Other Training/Education
82. In addition to your work history (see next), what other experiences, skills or qualifications would especially suit you for this position:
86. Work History
    List your relevant employment history, including all jobs held for at least the past 10 years. Use separate sheets if necessary.
88. Most Recent Employer
89. Phone
91. Address
93. City
94. State
95. Zip
97. Date Started
98. Date Left
100. Starting Position
101. Position Upon Leaving
103. Name and Title of Last Supervisor
104. Reason for Leaving
106. Description of Duties
     Number of people supervised, if appropriate
110. Previous Employer
111. Phone
113. Address
115. City
116. State
117. Zip
119. Date Started
120. Date Left
122. Starting Position
123. Position Upon Leaving
125. Name and Title of Last Supervisor
126. Reason for Leaving
128. Description of Duties
     Number of people supervised, if appropriate
132. Previous Employer
133. Phone
135. Address
137. City
138. State
139. Zip
141. Date Started
142. Date Left
144. Starting Position
145. Position Upon Leaving
147. Name and Title of Last Supervisor
148. Reason for Leaving
150. Description of Duties
     Number of people supervised, if appropriate
154. Previous Employer
155. Phone
157. Address
159. City
160. State
161. Zip
163. Date Started
164. Date Left
166. Starting Position
167. Position Upon Leaving
169. Name and Title of Last Supervisor
170. Reason for Leaving
172. Description of Duties
     Number of people supervised, if appropriate
176. References
     List two people not related to you who have known you for at least 1 year.
178. Reference 1
180. Name
182. Address
184. City
185. State
186. Zip
188. Phone
190. Relationship
191. Years Acquainted
195. Reference 2
197. Name
199. Address
201. City
202. State
203. Zip
205. Phone
207. Relationship
208. Years Acquainted
210. Reference 1
212. Name
214. Address
216. City
217. State
218. Zip
220. Phone
222. Relationship
223. Years Acquainted
225. Reference 1
227. Name
229. Address
231. City
232. State
233. Zip
235. Phone
237. Relationship
238. Years Acquainted
242. Emergency Contact Information
244. Name
246. Address
248. City
249. State
250. Zip
252. Phone
253. Alternate Phone
257. Please Read Before Signing

     I certify that all statements made by me on this application, my resume and any other accompanying documents are true and complete to the best of my knowledge, and that I have withheld nothing which, if disclosed, would materially alter or contradict the facts contained therein. I understand that false statements, omissions or misrepresentations may result in the disqualification of this application for employment with the City, or a withdrawal of any offer of employment, or if so employed, my dismissal from such employment.
     
     I authorize my previous employers, schools which I attended and character references to provide any and all information pertaining to my tenure or contact with them, which is relevant to this application for employment; and I agree that persons or organizations providing such information, or the City Of Westbrook, shall not be liable should the information so provided warrant my disqualification from employment with the City or if employed, my dismissal from such employment.
     
     I understand that it will be necessary to conduct a personal background, credit and reference check, and if the position warrants it, criminal histories check. I hereby authorize the City to conduct such an examination and persons or organization contacted to provide such information.
     
     I further understand that any offer of employment is conditional upon satisfactory completion of a physical examination at the City's expense, when the nature of the position requires one, and that the examination will focus on my present ability to perform the essential functions of the position.

     1. I Agree
261. Fair Credit Reporting Act Consumer Disclosure and General Authorization

     In connection with my application for employment with the City of Westbrook, Maine ("City"), I understand that a consumer report or investigative consumer report, as those terms are defined in the federal Fair Credit Reporting Act as amended ("FCRA"), 15 U.S.C. 1681 et seq., may be obtained by the City from a consumer reporting agency ("Agency"). I further understand that the Agency may not give out information about me to the City without my written consent. It is also understood that the Agency may not report medical information about me to the City without my specific prior consent as to the release of such information, which is in addition to my general authorization herein.
     
     I understand that an investigative consumer report is a special type of consumer report in which information about my character, general reputation, personal characteristics, and mode of living is obtained through personal interviews. In the event an investigative consumer report is obtained, I understand that I (a) am entitled to receive a summary of my rights, and (b) have the right to request additional disclosures provided for below as follows:
     
     Upon my written request to the City within a reasonable period of time after my receipt of this Fair Credit Reporting Act Consumer Disclosure and Genera/ Authorization, the City shall make a complete and accurate disclosure of the nature and scope of the investigation requested. It is understood that this disclosure shall be made in writing mailed, or otherwise delivered, to me not later than 5 days after the date on which the request for such disclosure was received from me or such report was first requested, whichever is later in time.
     
     I hereby authorize the City now, or at any time while I am employed by the City, to obtain a consumer report or investigative consumer report on me, as applicable. This authorization does not include the release of my medical information. I further acknowledge that I have received a summary of my rights under the FCRA.

     1. I Agree
263. A Summary of Your Rights Under the Fair Credit Reporting Act
     The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every' "consumer reporting agency" (CRA). Most CRAS are credit bureaus that gather and sell information about you - such as if you pay your bills on time or have filed bankruptcy - to creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C. 1681 et seq., at the Federal Trade Commission's website. The FCRA gives you specific rights, as outlined below. You may have additional rights under state law. You may contact a state or local consumer protection agency or state attorney general to learn those rights.
     
     - You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you - such as denying an application for credit, insurance, or employment - must tell you, and give you the name, address and phone number of the CRA that provided the consumer report.
     
     - You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently. There is no charge for the report if a person had taken action against you because of the information supplied by the CRA, if you request the report within sixty days of receiving notice of the action. Where applicable, you also are entitled to one free report every twelve months upon request if you certify that (1) you are unemployed and plan to seek employment within sixty days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight dollars.
     
     - You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit. Unless you evidence is frivolous. The source must review your evidence and report its findings to the CRA. (The source must also advice national CRAS - to which it has provided data - of any error.) The CRA must give you a written report of the investigation and a copy of your report if the investigation results in any change. If the CRA's investigation does not resolve the dispute, you may add a brief statement to your file. The CRA must normally include a summary of your statement in future reports If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change.
     
     - Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within thirty' days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change in your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source.
     
     - You can dispute inaccurate items with the source of the information. If you tell anyone - such as a creditor who reports to the CRA - that you dispute an item. They may not then report the information to the CRA without including a notice of your dispute. In addition, once you're notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error.
     
     - Outdated information must not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies.
     
     - Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRA - usually to consider an application with a creditor, insurer, employer, landlord, or other business.
     
     - Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your employer, or prospective employer, without your written consent. A CRA may not report medical information about you to creditors, insurers, or employers without your permission.
     
     - You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.
     
     - You may seek damages from violators. If a CRA, a user of (in some cases) a provider of CRA data, violates the FCRA, you may sue them in state or federal court.
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