Form Center

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 six (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 one (1) year, during which they may be reconsidered for existing vacancies, upon request of the applicant.

   6. 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 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. First Name*
13. Middle
14. Last Name*
16. Give any other names you have used or have been known by (including nicknames)
18. Email*
20. Street Address*
22. City*
23. State*
24. Zip*
26. Primary Phone*
27. Alternate Phone
29. Willing to Relocate?

    1. Yes

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

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

    1. Yes

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

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

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

    1. Yes

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

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

    1. Yes
    2. No
56. If Yes, please explain (suspension/revocation will not necessarily disqualify an applicant for employment.
58. Do you currently reside in one of the following 22 neighboring cities/towns: Westbrook, Portland, South Portland, Scarborough, Gorham, Windham, Falmouth, Cape Elizabeth, Old Orchard, Saco, Buxton, Standish, Gray, Cumberland, North Yarmouth, Biddeford, Yarmouth, Freeport, Hollis, Raymond, Limington and Sebago?

    1. Yes

    1. No
62. For Fire Department Positions
64. Position Applied For

    1. Career
    2. Part-Time

    1. Call
    2. Fire

    1. EMS
    2. Per Diem
66. EMS License #
67. EMS Level
69. Do you possess a driver's license?

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

    1. Yes
    2. No
75. If yes, provide the city, state and date issued
77. Are you able to work all shifts?

    1. Yes

    1. No
79. Why do you want to be a member of the Westbrook Fire and Resume Department?
81. What contributions do you think you would make to the department?
85. For Dispatch Postions
87. Do you possess a driver's license?

    1. Yes
    2. No
88. Issue Date
89. Class
90. State
92. Did you ever possess a driver's license issued by any state other than Maine?

    1. Yes
    2. No
93. If yes, provide the city, state and date issued?
95. Are you willing to submit a polygraph examination in order to establish the integrity of this application?

    1. Yes

    1. No
96. Of No, please state your reason(s)?
98. Why do you want to be a Public Safety Dispatcher in the Westbrook Communications Department?
102. Education
104. High School
106. Name and Location of School*
108. Year Graduated
110. Diploma/Degree
114. College/University
116. Name and Location of School
118. Year Graduated
119. Major
121. Diploma/Degree
125. College/University
127. Name and Location of School
129. Year Graduated
130. Major
132. Diploma/Degree
136. Other Training/Education
142. Work Experience

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

144. Most Recent Employer*
145. Phone
147. Address
149. City
150. State
151. Zip
153. Date Started*
154. Date Left
156. Starting Job Title*
157. Job Title Upon Leaving
159. Name and Title of Last Supervisor
160. Reason for Leaving
162. Description of Duties*

     Number of people supervised, if appropriate

166. Previous Employer
167. Phone
169. Address
171. City
172. State
173. Zip
175. Date Started
176. Date Left
178. Starting Job Title
179. Job Title Upon Leaving
181. Name and Title of Last Supervisor
182. Reason for Leaving
184. Description of Duties
     Number of people supervised, if appropriate
188. Previous Employer
189. Phone
191. Address
193. City
194. State
195. Zip
197. Date Started
198. Date Left
200. Starting Job Title
201. Job Title Upon Leaving
203. Name and Title of Last Supervisor
204. Reason for Leaving
206. Description of Duties
     Number of people supervised, if appropriate
210. Previous Employer
211. Phone
213. Address
215. City
216. State
217. Zip
219. Date Started
220. Date Left
222. Starting Job Title
223. Job Title Upon Leaving
225. Name and Title of Last Supervisor
226. Reason for Leaving
228. Description of Duties
     Number of people supervised, if appropriate
230. In addition to your work history (see next), what other experiences, skills or qualifications would especially suit you for this position:
234. Military Service
236. Have you ever served in a military organization of the United States?

     1. Yes

     1. No
238. If yes, please provide the branch of service
240. Please provide the period(s) of military services (active or reserve)
242. From
     From
243. To
     To
245. From
     From
246. To
     To
248. Were you ever court-martialed, tried on charges, the subject of Summary Court or received an Article 15?

     1. Yes

     1. No
250. If yes, give details of charges and disposition
252. 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
254. State if active or inactive

     1. Active
     2. Inactive
256. Branch
257. Unit
258. Rank
259. Serial #
261. To
     To
262. From
     From
266. 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.

268. Reference 1
270. Name*
272. Address
274. City
275. State
276. Zip
278. Phone*
280. Relationship*
281. Years Acquainted*
285. Reference 2
287. Name*
289. Address
291. City
292. State
293. Zip
295. Phone*
297. Relationship*
298. Years Acquainted*
300. Reference 3
302. Name*
304. Address
306. City
307. State
308. Zip
310. Phone*
312. Relationship*
313. Years Acquainted*
315. Reference 4
317. Name
319. Address
321. City
322. State
323. Zip
325. Phone
327. Relationship
328. Years Acquainted
330. Reference 5
332. Name
334. Address
336. City
337. State
338. Zip
340. Phone
342. Relationship
343. Years Acquainted
347. Emergency Contact Information
349. Name
351. Address
353. City
354. State
355. Zip
357. Phone
358. Alternate Phone
362. 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 authorize, without reservation, the employer, its representatives, employees or agents 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.

     
     

     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
366. 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
368. 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.
372. For Fire Department: General Authorization for Release and Waiver

     I hereby authorize any and all schools, physicians, hospitals, Armed Services, current and all previous employers, law enforcement agencies, any other person, organization or agency to furnish the Westbrook Police Department, or its designated agent(s), any and all information, or documents which may be requested, including a consumer credit report; to allow the visual inspection and copy of all reports, photographs, or other documents. 

      

     I hereby waive any objection to the release of said information and grant to the Westbrook Public Safety Commission or its designated agent(s) any right I may have to said information. Further I hereby release all of the above, the City of Westbrook, and its designated agent(s) from any and all liability for any damage whatsoever arising therefrom. 

      

     I also authorize investigation of all statements made in my application for employment. I understand that in the event of my employment with the City of Westbrook, I shall be subject to dismissal if any of the information I have given in this application is false, or if I have failed to give any material information herein requested.

     1. I agree
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374. 1. Receive an email copy of this form.
375. Email address

     This field is not part of the form submission.

376. Submit

* indicates a required field