Instructions For Completing And Submitting The State Of Connecticut Application For Examination Or Employment (Form Ct-Hr-12) (Fillible) (Page 6 of 12) in pdf

PAGE FIVE

________________________________________

_______________________ ____

Last Name

First Name

______________________________________________________________________

Examination Title or Position Title

SECTION 7: EMPLOYMENT HISTORY

Important Instructions for Completing this Section. Beginning with your PRESENT or MOST RECENT employment

or volunteer experience and working backward, list all positions held that you wish to be considered toward meeting the

eligibility requirements (minimum qualifications) stated on the exam announcement or job posting. List all positions (job

titles) separately, even if with the same employer. Provide the starting and ending dates (month, day and year) of

your employment for each position and indicate if the position was full or part time and the number of hours worked per

week. Clearly describe the work (duties) you personally performed in each position. If a job included a mixture of relevant

duties and other duties that are not relevant toward meeting the eligibility requirements, specify the percentage of time

spent performing each duty. Number your jobs, starting with your most recent job as number 1. Make additional copies

of this page as needed to list additional positions, and continue the number sequence. If you need additional space

for the descriptions of your duties for one or more positions, attach an 8 1/2” x 11” sheet with your name and the exam

number or position title and continue the descriptions of your duties, using the number sequence to identify which

positions the duties belong to. You must fill out this application completely even if you attach a resume. Failure to

provide all of the REQUIRED information for each position (or job title) held may result in your application being

disapproved. Although a resume can be attached, only jobs included in this section of the application form will be

considered when determining if you meet the required minimum qualifications for the exam or position for which you are

applying.

POSITION 1: ________________________________________ _____________________________________________

Most Recent Official Job Title

Company Name/Department where assigned

_________________________________________________

____________________

_______

____________

Business Address (P.O. Box or # and Street)

City

State

Zip Code

___________________________________________

_________________________________________________

Type of Business

Official Job Title of Immediate Supervisor

Dates of Employment: From: ___/____/____To:___________

Phone Number: ________________________

(MM/DD/YY)

(MM/DD/YY

Annual Salary/Hourly Wage: ______________

or Present)

This job is/was: ___ Full-time

___ Part-time

____ Per Diem

Number of Hours Worked per week: _______

Number & Job Titles of Employees Supervised by you: ____________________________________________________

Reason for leaving: ________________________________________________________________

List all major duties and responsibilities performed by you in this job. (This area must be completed for each job listed.)

Instructions For Completing And Submitting The State Of Connecticut Application For Examination Or Employment (Form Ct-Hr-12) (Fillible) Page 6

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