Human Resources Department
58 Opera House Square
Claremont, NH 03743
MILITARY
Have you ever served in the U.S. Armed Forces?
Yes_____
No_____
If yes, what branch?_________________________________________________________________________________
Type of discharge?_________________________________________________________________________________
Describe any training received which would be relevant to the position you are applying:___________________________
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SPECIAL SKILLS
List technical/professional licenses or certification you hold:__________________________________________________
_________________________________________________________________________________________________
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List office machines, heavy equipment, vehicles and other machinery you can operate:____________________________
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Indicate any specialized training you have received:________________________________________________________
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DRIVING HISTORY
(USE ADDITIONAL SHEETS AS NECESSARY)
List ALL presently unexpired motor vehicle operator’s licenses you hold:
License#____________________________ Issuing State:_________ Expires:_____________ Type:_______________
License#____________________________ Issuing State:_________ Expires:_____________ Type:_______________
Date of Birth:___________________________________________ (Necessary to conduct motor vehicle records check.)
Provide complete motor vehicle accident record for past 7 years
Dates
Nature of Accident (head-on, rear-end, etc.)
___________________________
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Last Accident
___________________________
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Next previous
___________________________
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Next Previous
Indicate ALL traffic convictions during the past 7 years (other than parking violations) and dates of ALL license
suspensions of forfeitures during the past 7 years
Location
Date
Description
_____________________________
____________________
____________________________________________
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____________________
____________________________________________
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CRIMINAL HISTORY
Have you ever been arrested for or convicted of a crime that has not been annulled by a court?
Yes_____
No_____
If yes, explain fully (Conviction will not automatically disqualify you from employment).
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