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Apply


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Contact Information




YesNo
YesNo
Full TimePart-TimeTemporary
YesNo
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Employment History



Beginning with the most recent, please list all employment, including part-time and self-employment, for the past 10 years. Attachment of resume in lieu of completing this section is acceptable.

From To
Name of Supervisor Title Salary
Reason for Leaving
Hiring Position Current or Last Position
Description of Duties:

YesNo

Employer
Address From To
Name of Supervisor Title Salary
Reason for Leaving
Hiring Position Current or Last Position
Description of Duties:

YesNo

Employer
Address From To
Name of Supervisor Title Salary
Reason for Leaving
Hiring Position Current or Last Position
Description of Duties:

YesNo

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Education

High School Address
From To Did You Graduate?
YesNo
College or University Address
From To Did You Graduate?
YesNo
Graduate School Address
From To Did You Graduate?
YesNo
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Please Read The Following Statements Carefully Before You Sign and Return This Application

References

Prior to an offer of employment, you will be required to provide the contact information for three professional references. I give the Lowell Housing Authority (LHA) the right to investigate all references provided in the application form and to secure additional information about me. This may include a criminal records check, motor vehicle/driving record check, as required by the position for which I am applying. I hereby release from liability the LHA and its representatives for seeking such information and all other person, corporations, or organizations for furnishing such information.

I have read, understand, and agree to this statement. Initial here

Physical Examination

Following an offer of employment, all perspective employees will be required to consent to physical examination. The only information that will be conveyed by the examining physician is whether you are able to perform the essential functions of the job. We cannot refuse to hire you if you are capable of performing the essential functions of the job with a reasonable accommodation. A physician is performing the exam on behalf of the Lowell Housing Authority; therefore, the physician will disclose the results to the Lowell Housing Authority. You are entitled, upon request, to a copy of said report.

I have read, understand, and agree to this statement. Initial here

Drug Screening

I understand that the LHA has a commitment to maintain an alcohol and drug-free workplace and that the LHA, unless prohibited by state law, requires perspective employees to consent to a pre-employment drug screening which will be performed at the time of the physical examination. I further understand and agree that if I am employed, I may be required to submit to alcohol/drug testing under certain circumstances during my employment.

I have read, understand, and agree to this statement. Initial here

Criminal Record

Have you ever been convicted of a felony? YesNo



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