Tot Hr Form 320 – Fill Out and Use This PDF

Application For	Town of Taos
Employment	400 Camino de la Placita
	Taos, New Mexico 87571

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, ancestry, age, marital status, veteran status or any other protected class, or the presence of a medical condition or disability (unless there exists a required bona fide occupational qualification for a position).

INSTRUCTIONS FOR COMPLETING THIS APPLICATION

Type or print in dark ink. If you need more space for an answer, use a sheet of paper the same size as this page.

Submit a separate application for each position for which you apply. If you plan to apply for more than one position, we suggest you complete the application, leaving "Date of Application," "Vacancy Announcement # or Job Title" and "Signature" blank. Make a copy of the application and complete this information as appropriate for each position for which you apply. We must have an original signature and date on each application received.

Read the recruitment announcement carefully for the position to which you are applying. Note the skills and knowledge required for the position. Assure that you meet the minimum qualifications set forth on the announcement.

Your completed application is one of the primary sources of information used in making selection decisions. Carefully complete each experience block describing your work or volunteer experience.

Vacancy Announcement # or Job Title:

Are you available to work (Check all that apply)

Full Time

Part Time

Temporary

PERSONAL INFORMATION

Name

LastFirstMiddle Initial

Physical Address

CityState Zip Code

Mailing Address

					City	State	Zip Code
Email Address
Telephone: Home			Other

TOT HR Form 320 Revised 04/10

Page 1 of 4

Education

		Vocational / Technical:					Hours Completed:
		School - Major Field:
		Business College:					Hours Completed:
		Major Field:
		College or University Name:
		Undergraduate					Graduate
	School(s):					School(s):
	Major Field(s)					Major Field(s)
	Hours Completed:					Hours Completed:
	Degree(s) Received:

(Copies of diploma and/or transcripts may be requested upon offer of employment)

1. License/Certificate Issued by:

Field / Trade / Specialization:

Lic. / Cert. Number:

Issue Date:

Exp. Date:

2. License/Certificate Issued by:

Field / Trade / Specialization:

Lic. / Cert. Number:

Issue Date:

Exp. Date:

State any additional information you feel may be helpful to us in considering your application.

The Town of Taos is a designated drug-free and violence-free workplace. Are you willing to submit to a full

background check, drug screening and alcohol screening?			Yes	No
If no, please explain:

TOT HR Form 320 Revised 04/10

Page 2 of 4

Professional References (Not Relatives)

Name	Address	Phone

Experience

May inquiry be made of your current and past employers regarding your character, qualifications and record of employment?

Yes	No	If no, please indicate to which employers it applies and why:

Note: Volunteer or unpaid but relevant experience may be considered in the same manner as paid experience. Verification of volunteer duty will be required.

1 Employer's Name or Organization Volunteered With		Type of Business			From (Mo./Yr.)	To (Mo./Yr.)
Employer's Address		City	State	Zip	Your Job Title
Supervisor's Name	Phone Number	Check One		Hours per Week	START Mo. Pay	LAST Mo. Pay
		Full-Time	Part-Time
If you supervised employees, please indicate number and give dates.		Location of employment (City & State) if different from employer's address.

Duties:

2 Employer's Name or Organization Volunteered With		Type of Business			From (Mo./Yr.)	To (Mo./Yr.)
Employer's Address		City	State	Zip	Your Job Title
Supervisor's Name	Phone Number	Check One		Hours per Week	START Mo. Pay	LAST Mo. Pay
		Full-Time	Part-Time
If you supervised employees, please indicate number and give dates.		Location of employment (City & State) if different from employer's address.

Duties:

TOT HR Form 320 Revised 04/10

Page 3 of 4

3 Employer's Name or Organization Volunteered With	Type of Business			From (Mo./Yr.)	To (Mo./Yr.)
Employer's Address	City	State	Zip	Your Job Title

If you supervised employees, please indicate number and give dates.

Location of employment (City & State) if different from employer's address.

Duties:

Additional Experience. Note: For additional experience blocks, please use continuation sheet.

I certify that the information contained in this application is correct and complete to the best of my knowledge and belief. I understand that knowingly making a false statement or omission in this application may be sufficient cause for rejection of this application or dismissal after employment. I give the Town of Taos the right to investigate all references and to secure additional information about me and my prior work history as indicated herein. I hereby release from liability the Town of Taos, its representatives, all references, schools and/or previous employers for furnishing such information. I understand that this application shall become a public record upon receipt and therefore shall be available for public inspection pursuant to law.

Signature of Applicant

Date

THANK YOU FOR TAKING INTEREST IN THE TOWN OF TAOS

TOT HR Form 320 Revised 04/10

Page 4 of 4

VOLUNTARY AFFIRMATIVE ACTION QUESTIONNAIRE

Applicants for employment by, and incumbent employees of, public agencies may be solicited to voluntarily declare their ethnic identification, provided this information shall be for research and statistical purposes only.

Please complete this section. It will be detached and kept separate and confidential. It will not be used in any way to make employment decisions.

Position:		Date:
Gender:
Male	Female
Is your age 40 or over?
Yes	No

Are you a person with a disability?

Yes

No

Will you require accomodations for testing and/or employment?

Yes

No

Indicate specific source from which you learned about the position:

Newspaper (specify):

Job Fair (specify):

Organization (specify):

Employee Referral (specify):

Website (specify):

Town of Taos Human Resources Department

New Mexico Department of Labor

Other (specify):

TOT HR Form 320 Supplement Revised 04/10