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Step One

VILLAGE OF BRIARCLIFF MANOR
Employment Application

Please TYPE or PRINT clearly. This application must be completed and signed personally by the applicant. Each question must be answered in full. We appreciate your interest in employment with the Village of Briarcliff Manor.
The Village of Briarcliff Manor is an Equal Opportunity Employer. We consider all applications for all positions without regard to race, color, religion, gender, national origin, age, physical or mental disability, marital status, veteran status, sexual orientation, arrest/criminal record, genetic predisposition or carrier status, or any other legally protected status or class. Applicants requiring a reasonable accommodation to participate in the application and/or interviewing process are encouraged to contact the Village Supervisor’s Office.
Biographical Data
Name (First, Middle, Last)*
Phone Number*
Address*
Email Address*
City*
State*
Zip Code*
Position Applied For*
Are You Available For*
1. Full-Time
1. Temporary
1. Part-Time
Date Available for Work*
Date Available for Work
How were you referred to the Village of Briarcliff Manor?*
1. Newspaper
2. Internet
1. Civil Service Job Posting
2. Walk-In
1. Employee Referral
1. Other
Employee Referral Name
If Other, Please Specify
Are you currently employed?*
1. Yes
1. No
If yes, may we contact your employer to obtain employment information?
1. Yes
1. No
Have you ever filed an application or interviewed for employment with the Village of Briarcliff Manor?*
1. Yes
1. No
If yes, give month and year
If yes, give month and year
Have you ever been employed with the Village of Briarcliff Manor before?*
1. Yes
1. No
If yes, give dates
If yes, give dates Start Date
—
If yes, give dates End Date
Are you legally eligible for employment in the United States? *
Employment eligibility verification will be required upon employment.
1. Yes
1. No
If you are under 18 years of age, can you provide required proof of your eligibility to work? *
1. Yes
2. No
1. Not Applicable
If you have been provided with a job description for the position for which you are applying, are you able to perform the essential functions of the position with or without reasonable accommodation?*
1. Yes
1. No
1. Not Applicable
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Step Two

Educational Background
High School or Preparatory School
Name & Location of School
Number of Years Completed
Course of Study
Diploma or Degree Obtained
College / University
Name & Location of School
Number of Years Completed
Course of Study
Diploma or Degree Obtained
Other
Name and Location of School
Number of Years Completed
Course of Study
Diploma or Degree Obtained
Skills
List certificates, licenses, or professional achievements that would support your qualifications for employment:
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Step Three

Present or Last Employer
Name of Employer
Phone Number
Address
City
State
Zip Code
Title of Position
Name & Title of Supervisor
Description of Duties, Responsibilities & Significant Accomplishments
Reason for Leaving
List your previous employers whether or not they seem relevant to the position for which you are applying.
Previous Employer
Name of Employer
Phone Number
Address
City
State
Zip Code
Title of Position
Name & Title of Supervisor
Description of Duties, Responsibilities & Significant Accomplishments
Reason for Leaving
Previous Employer
Name of Employer
Phone Number
Address
City
State
Zip Code
Title of Position
Name & Title of Supervisor
Description of Duties, Responsibilities & Significant Accomplishments
Reason for Leaving
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Step Four

US Military History
Were You in the Military?
1. Yes
1. No
U.S. Military Branch
Entry Date
Entry Date
Discharge Date
Discharge Date
Training or Specialty
References
Name/Occupation*
Years Known*
Email Address*
Phone Number*
Name/Occupation*
Years Known*
Email Address*
Phone Number*
Name/Occupation
Years Known
Email Address
Phone Number
I certify that the facts contained on this application are true and complete to the best of my knowledge. I understand that any misrepresentation is cause for voiding this application or termination of employment, if hired. I authorize investigation of any information provided on this application form. I also authorize investigation of my employment record, background and references and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may be terminated at any time, subject to applicable federal, state and/or local rules and regulations and/or collective bargaining agreements. For positions subject to the federal Department of Transportation regulations regarding controlled substances and alcohol use testing (Part 382), I understand that as a condition for employment with the Village of Briarcliff Manor, a pre-employment controlled substance test will be required and must be passed.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date
Date

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Step One

VILLAGE OF BRIARCLIFF MANOR

Employment Application

Biographical Data

Step Two

Educational Background

High School or Preparatory School

College / University

Other

Skills

Step Three

Present or Last Employer

Previous Employer

Previous Employer

Step Four

US Military History

References

Contact Us

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