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Employment Application

125 B Eastview St.
Dayton, VA 22821
(540) 879-2241

The Town of Dayton is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status.

This application for employment is good for 30 days only. Consideration for employment after 30 days requires a new application.

PERSONAL:
Name
Address
(If offered employment, you will be required to provide documentation to verify eligibility.)
EDUCATION: Please indicate education or training which you believe qualifies you for the position you are seeking.
High School:
College and/or Vocational School:
Other Training or Degrees:
PROFESSIONAL LICENSE OR MEMBERSHIP:
(You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status.)
OFFICE SKILLS:
EMPLOYMENT: List last employer first, including U.S. Military Service.
Dates of Employment:
Employer
Dates of Employment:
Employer
Dates of Employment:
If you wish to describe additional work experience, attach the above information for each position on a separate piece of paper.
PROFESSIONAL REFERENCES ONLY:
PROFESSIONAL REFERENCES ONLY:
PROFESSIONAL REFERENCES ONLY:
APPLICANT'S CERTIFICATION AND AGREEMENT
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize the Town of Dayton to verify their accuracy and to obtain reference information on my work performance. I hereby release the Town of Dayton from any/all liability of whatever kind and nature which, at any time, could result from obtaining and basing an employment decision on such information. I understand that falsified statements of any kind or omissions of facts called for on this application may result in disqualification for consideration for employment or, if already employed, grounds for immediate dismissal. I understand that should an employment offer be extended to me and accepted, I will fully adhere to the policies, rules and regulations of employment of the Town of Dayton. However, I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Town of Dayton may terminate my employment at any time with or without notice or cause.