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Town of Winchester 71 Mt. Vernon Street Winchester, MA 01890

List present employment first. Account for the past ten (10) years. Include United States military service. A resume or supplemental sheet may be included, however, this section must be completed. You may include any verified volunteer employment.

In order to prevent bias or favoritism because of family relationships, the following information is required.

1. It is a violation of Massachusetts General Law to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law is subject to criminal penalties and civil liability.

2. I understand that any offer of employment that I receive from the Town of Winchester is contingent upon my successful results of the pre-employment screening process including, but not limited to, the Town of Winchester receiving satisfactory references, a satisfactory criminal history and Criminal Offense Record Inquiry (CORI) and/or credit check if required, satisfactory verification of driver's license or other certifications or licensing, and satisfactory results of any required post-offer pre-employment drug test or physical examination.

3. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, including contacting present and former employers, and I authorize present and former employers and references to provide information to the Town as needed to consider my application. I hereby release the Town, my present and former employers and all individuals contacted for factual information about me from any and all liability for damages arising from furnishing the requested information.

I certify that all statements made by me on this application are true, complete and correct to the best of my knowledge and understand that any falsifications or omissions may be cause for forfeiture on my part of all rights to employment with the Town of Winchester and may subject me to disqualification or dismissal.