State of Maine Employment Application - Free Download
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State of Maine Employment Application
State of Maine Employment Application
Page 1 of 8 PER 3 - 12/08
State of Maine
(An Equal Opportunity Employer)
Employment Application
(revised December 2008)
Last Name
First Name
M.I.
Social Security
Number
Have you ever worked, attained licensing or certification, attended school or been convicted of a criminal offense under a
different name
Yes No
If so, what is that name
Name #1
_________________________________
Name #2
_________________________________
Name #3
_________________________________
Name #4
_________________________________
Mailing Address
Town
State
ZIP Code
Home Phone #
Work Phone #
Email Address
Title of the Job You’re Applying For
Job Class Code
Veteran’s Preference:
See pamphlet “Veteran’s Preference in Maine State Service” or go to
www.maine.gov/bhr/state_jobs/veteran.htm for more information. Provide DD214 and disability forms if applicable.
Not Claimed
5 Points (Requires DD214)
10 Points (Requires DD214 and VA Statement of Disability)
Only U.S. citizens or aliens who have a legal right to work and remain permanently in the U.S. are eligible for
employment. Can you, after employment, submit verification of your legal right to work in the United States
YesNo
Are you at least 18 years of age Yes No
Are you a present or former Maine State employee Yes No
Department
___________________
Job Title
___________________________________
Begin Date
______________
End Date
______________
Are you willing to work: Saturdays Sundays Holidays
Do you have a current Maine driver’s license Yes No
If yes, what type Class A Class B Class C
Are you willing to travel on the job Yes No
If yes, are you willing to use your own vehicle Yes No
Are you willing to work overtime Yes No What shifts are you willing to work 1
st
2
nd
3rd
ADMINISTRATIVE SKILLS (subject to formal testing and work sampling) WORDS PER MINUTE
Typewriter: Keyboarding:
FOREIGN LANGUAGE SKILLS
Language __________________________ Speak Read Write
Language __________________________ Speak Read Write
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