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2. Thank you for your interest in employment with the City of Westbrook.
4. General Information and Instructions

   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.

   We value a diverse workforce and workplace and strongly encourage women, people of color, LGBT+ individuals, people with disabilities, members of ethnic minorities, foreign-born residents, and veterans to apply. 

   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.

   Once you click "Submit", your applications will be sent to the City of Westbrook, Human Resources Department. The Human Resources Department can be emailed at HR@Westbrook.me.us.

8. Personal Information
10. First Name*
11. Middle
12. Last Name*
14. Give any other names you have used or have been known by (including nicknames)
16. Email*
18. Street Address*
20. City*
21. State*
22. Zip*
24. Primary Phone*
25. Alternate Phone
27. Willing to Relocate?

    1. Yes

    1. No
29. Position Applied For*
30. When Can You Start
32. Please provide your desired salary range*
33. How did you hear about this position?*
35. Do you have any relatives currently working for the City of Westbrook?*

    1. Yes
    2. No
36. If yes, please state the employee's name and relationship
38. Are you authorized to work in the United States on an unrestricted basis?*

    1. Yes

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

    1. Yes
    2. No
41. Have you ever applied for employment or worked here before?*

    1. Yes
    2. No
42. If yes to either, please give details.
44. Can you perform these essential functions with or without reasonable accommodations?*

    1. Yes

    1. No
48. For Public Services Positions
50. Do you currently hold a valid State of Maine commercial driver's license?

    1. Yes
    2. No
51. If Yes, please list any additional License Endorsements:
53. Have you ever had your driver’s license suspended or revoked?

    1. Yes
    2. No
54. If Yes, please explain (suspension/revocation will not necessarily disqualify an applicant for employment.
58. For Fire Department Positions
60. Position Applied For

    1. Career/Full-TIme

    1. Per Diem

    1. Call Fire
62. EMS License #
63. EMS Level
65. Do you possess a driver's license?

    1. Yes
    2. No
66. Issue Date
67. Class
68. State
70. Did you ever possess a driver’s license issued by any state other than Maine?

    1. Yes
    2. No
71. If yes, provide the city, state and date issued
75. For Dispatch Postions
77. Do you possess a driver's license?

    1. Yes
    2. No
78. Issue Date
79. Class
80. State
82. Did you ever possess a driver's license issued by any state other than Maine?

    1. Yes
    2. No
83. If yes, provide the city, state and date issued?
87. Education
89. High School
91. Name and Location of School*
93. Year Graduated
95. Diploma/Degree
99. College/University
101. Name and Location of School
103. Year Graduated
104. Major
106. Diploma/Degree
110. College/University
112. Name and Location of School
114. Year Graduated
115. Major
117. Diploma/Degree
121. Other Training/Education
127. Work Experience

     List your relevant employment history, including all jobs held for at least the past 10 years. 

129. Most Recent Employer*
130. Phone
132. Address
134. City
135. State
136. Zip
138. Date Started*
139. Date Left
141. Starting Job Title*
142. Job Title Upon Leaving
144. Name and Title of Last Supervisor
145. Reason for Leaving
147. Description of Duties*

     Number of people supervised, if appropriate

151. Previous Employer
152. Phone
154. Address
156. City
157. State
158. Zip
160. Date Started
161. Date Left
163. Starting Job Title
164. Job Title Upon Leaving
166. Name and Title of Last Supervisor
167. Reason for Leaving
169. Description of Duties
     Number of people supervised, if appropriate
173. Previous Employer
174. Phone
176. Address
178. City
179. State
180. Zip
182. Date Started
183. Date Left
185. Starting Job Title
186. Job Title Upon Leaving
188. Name and Title of Last Supervisor
189. Reason for Leaving
191. Description of Duties
     Number of people supervised, if appropriate
195. Previous Employer
196. Phone
198. Address
200. City
201. State
202. Zip
204. Date Started
205. Date Left
207. Starting Job Title
208. Job Title Upon Leaving
210. Name and Title of Last Supervisor
211. Reason for Leaving
213. Description of Duties
     Number of people supervised, if appropriate
215. In addition to your work history (see next), what other experiences, skills or qualifications would especially suit you for this position:
219. Military Service
221. Have you ever served in a military organization of the United States?

     1. Yes

     1. No
223. If yes, please provide the branch of service
225. Please provide the period(s) of military services (active or reserve)
227. From
     From
228. To
     To
230. From
     From
231. To
     To
233. Were you ever court-martialed, tried on charges, the subject of Summary Court or received an Article 15?

     1. Yes

     1. No
235. If yes, give details of charges and disposition
237. Are you currently an Active or Inactive member of the Reserves Forces (any branch), or National Guard of the United States of any foreign government?

     1. Yes

     1. No
239. State if active or inactive

     1. Active
     2. Inactive
241. Branch
242. Unit
243. Rank
244. Serial #
246. To
     To
247. From
     From
251. References

     List three (3) people not related to you who have known you for at least one (1) year.

     For Fire Department: Please list five (5) professional references.

253. Reference 1
255. Name*
257. Address
259. City
260. State
261. Zip
263. Phone*
265. Relationship*
266. Years Acquainted*
270. Reference 2
272. Name*
274. Address
276. City
277. State
278. Zip
280. Phone*
282. Relationship*
283. Years Acquainted*
285. Reference 3
287. Name*
289. Address
291. City
292. State
293. Zip
295. Phone*
297. Relationship*
298. Years Acquainted*
304. 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 of Westbrook, or a withdrawal of any offer of employment, or if so employed, my dismissal from such employment.

     I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the City of Westbrook to hire me. 

     I authorize, without reservation, the City of Westbrook to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resumé or job interview.  I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.  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.

     
     

     
     

     1. I Agree
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310. 1. Receive an email copy of this form.
311. Email address

     This field is not part of the form submission.

312. Submit

* indicates a required field