Form Center

Step One

Highway Seasonal Application
Please use the interactive online form below to request seasonal employment at the Highway Department.
Position
Department Interested In*
1. Highway Department
2. 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?*
1. Yes
1. No
If yes, when, where and in what position:
Title*
1. Mr.
2. Ms.
3. 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?*
1. Yes
2. No
Are you a resident of Brookhaven?*
1. Yes
2. No
Are you a citizen of the United States?
1. Yes
2. No
If not, are you legally eligible to work in this country?
Do you possess a valid New York State License?
1. Yes
2. No
Do you possess a valid CDL license?
1. Yes
2. No
Have you ever been convicted of a felony, misdemeanor or violation other than a non-moving traffic violation?
1. Yes
2. 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?
1. Yes
2. 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?
1. Yes
2. 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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Highway Seasonal Application

Steps

Step One

References

Work History

Education

Brookhaven Town Hall

Comments/Concerns

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