Instructions For Completing And Submitting The State Of Connecticut Application For Examination Or Employment (Form Ct-Hr-12) (Fillible) Page 10
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12PAGE NINE
________________________________________
_______________________ ____
Last Name
First Name
MI
______________________________________________________________________
Examination Title or Position Title
SECTION 9: POSITION INFORMATION
What type(s) of position(s) will you consider? Answer both 1 and 2.
1. __Full-Time only
__Part-Time only
___ Either Part-time or Full-time
2. __Permanent only
__Nonpermanent only
___ Either Permanent or Nonpermanent
What shift would you be willing to work? Check all that apply:
____Day (First Shift)
____
Evening (Second Shift)
____
Night (Third Shift)
____Weekends
SECTION 10: EMPLOYMENT DISTRICTS
Check the box(es) for ONLY the district(s) in which you will accept employment. Indicate your choice of
location preference(s) in the left hand column by checking the appropriate box(es) where you are willing to
work. Not all jobs are used in all locations. Names will be certified by location at the request of the
appointing authority.
__ A All Locations
__ B Greenwich, Stamford, New Canaan, Darien
__ C Norwalk, Wilton, Weston, Westport
__ D Fairfield, Easton, Monroe, Trumbull, Shelton, Stratford, Milford
__ E Bridgeport
__ F Redding, Ridgefield, Danbury, Bethel, Newton, Brookfield, New Fairfield, Bridgewater, Sherman,
New Milford, Roxbury, Washington, Kent, Warren
__ G Morris, Litchfield, Harwinton, New Hartford, Torrington, Goshen, Cornwall, Sharon, Salisbury,
Canaan, North Canaan, Norfolk, Colebrook, Winchester, Hartland, Barkhamsted
__ H Thomaston, Bethlehem, Watertown, Woodbury, Southbury, Middlebury, Beacon Falls, Naugatuck,
Prospect, Waterbury, Wolcott, Cheshire
__ I
Oxford, Seymour, Ansonia, Derby
__ J West Haven, Orange, Woodbridge, Bethany, Hamden, North Haven, East Haven, North Branford,
Wallingford, Branford, Guilford, Madison, Clinton
__ K New Haven
__ L Meriden
__ M Plymouth, Bristol, Burlington
__ N Berlin, Southington, Plainville, New Britain
__ O Avon, Farmington, West Hartford
__ P East Hartford, Manchester
__ Q Hartford
__ R Granby, Canton, Simsbury, Suffield, East Granby, Windsor Locks, Windsor, Bloomfield, East
Windsor, South Windsor, Ellington, Vernon, Tolland, Stafford, Willington
__ S Enfield, Somers
__ T Newington, Wethersfield, Rocky Hill
__ U Union, Ashford, Mansfield, Chaplin, Hampton, Windham, Scotland, Lebanon
__ V
Cromwell, Portland, Middletown, Middlefield, Durham, East Hampton, Haddam, East Haddam,
Chester, Essex, Killingworth, Deep River, Westbrook, Old Saybrook
__ W Lyme, Old Lyme, East Lyme, Salem, Montville, Waterford, New London, Ledyard, Groton,
Stonington, North Stonington
__ X Bozrah, Franklin, Norwich, Sprague, Lisbon, Preston, Griswold, Voluntown
__ Y Woodstock, Thompson, Putnam, Pomfret, Eastford, Brooklyn, Canterbury, Plainfield, Sterling,
Killingly
__ Z Glastonbury, Marlborough, Colchester, Hebron, Columbia, Andover, Bolton, Coventry
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