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Highway Seasonal Application
This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Step One
This section is complete
This section is incomplete
2.
References
This section is complete
This section is incomplete
3.
Work History
This section is complete
This section is incomplete
4.
Education
This section is complete
This section is incomplete
Step One
Highway Seasonal Application
Please use the interactive online form below to request seasonal employment at the Highway Department.
Position
Department Interested In
*
Highway Department
All Other Departments (not including Highway)
Wrong Application
Go To Main Seasonal Application (Non-Highway Department)
You answered you are interested in working for all Town departments except the Highway Department. You must use our
main seasonal application
for this purpose.
What hours are you available to work?:
*
Available to work from:
*
Available to work from:
Available to work to:
*
Available to work to:
Were your previously employed by us?
*
Yes
No
If yes, when, where and in what position:
Title
*
Mr.
Ms.
Mrs.
Last Name
*
First Name
*
Middle Name
Street Address
*
Apartment Number
P.O. Box
City
*
State
*
Zip Code
*
Primary Phone Number
*
Alternate Phone Number
Email Address
*
Do you have transportation to the location you may be assigned?
*
Yes
No
Are you a resident of Brookhaven?
*
Yes
No
Are you a citizen of the United States?
Yes
No
If not, are you legally eligible to work in this country?
Do you possess a valid New York State License?
Yes
No
Do you possess a valid CDL license?
Yes
No
Have you ever been convicted of a felony, misdemeanor or violation other than a non-moving traffic violation?
Yes
No
If yes, please explain
Do you have any relatives, by blood, marriage or other legal process, who currently work for the Town of Brookhaven or have worked for the Town of Brookhaven in the past?
Yes
No
Do you have any relatives, by blood, marriage, or other legal process, who currently work or have previously worked for the Town of Brookhaven as an elected official, a Bingo Inspector, or a member of an appointed board?
Yes
No
If yes, please list names(s) and their relation to you
Continue
References
Reference 1 (Three required, no relatives)
Reference Name
*
Reference Address
*
City
*
State
*
Zip Code
*
Reference Phone Number
*
Reference 2
Reference Name
*
Reference Address
*
City
*
State
*
Zip Code
*
Reference Phone Number
*
Reference 3
Reference Name
*
Reference Address
*
City
*
State
*
Zip Code
*
Reference Phone Number
*
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Work History
Name of Employer
Address
City
State
Zip Code
Position
Description of Duties
Employed From:
Employed From:
Employed To:
Employed To:
Last Salary
Reason for Leaving
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Education
High School Name
*
Town, State
*
As of date applying, check all completed years
*
9
10
11
12
Did you receive a diploma?
*
Yes
No
If you did not receive a diploma, did you receive a GED?
Yes
No
N/A
Issuing Authority of GED
Post Secondary Education: Name of Institution
Number of Credits Earned
Type of Course or Major Subject
Did you earn a degree?
Yes
No
Type of Degree Received
Date Degree Received
Date Degree Received
Qualifications and Experience
*
Please Attach Copies of All Certfications
Applicant Printed Signature (Legal Name Required)
*
Applicant's Statement The fact set forth on this application are true and complete. I understand that any false statement is cause for immediate dismissal. I also understand that taking a vacation during my summer employment and/or failing to notify my supervisor if I will be absent could result in my immediate dismissal. I further understand, depending upon the position or program to which I am assigned, I will be obliged to work weekends, and at the hours and location the position requires. I am or will be 16 years of age on or before July 1st of this calendar year. I understand by submitting this application, it is not an offer or guarantee of employment.
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