Instructions For Completing And Submitting The State Of Connecticut Application For Examination Or Employment (Form Ct-Hr-12) (Fillible) Page 7
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12PAGE SIX
________________________________________
_______________________ ____
Last Name
First Name
MI
______________________________________________________________________
SECTION 7: EMPLOYMENT HISTORY (CONTINUED)
Examination Title or Position Title
POSITION 2: ________________________________________ _____________________________________________
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: ______________
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.)
POSITION 3: ________________________________________ _____________________________________________
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: ______________
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.)
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