State of Maine Employment Application

State of Maine
(An Equal Opportunity Employer)
Employment Application
(revised February 2015)
Last Name
First Name
M.I.
Social Security Number
Have you ever worked, attained licensing or certification, attended school or been convicted of a criminal
offense under a different name?
Yes No If so, what is that name? (enter below)
Name #2
Name #4
Town
State
ZIP Code
Home Phone #
Work Phone #
Email Address
Title of the Job You’re Applying For
Job Class Code
Veteran’s Preference: See pamphlet “Veteran’s Preference in Maine State Service” or go to
http://www.maine.gov/bhr/rules_policies/policy_manual/5_1.htm for more information. Provide DD214 and disability
forms if applicable.
Not Claimed
5 Points (Requires DD214)
10 Points (Requires DD214 and VA Statement of Disability)
Only U.S. citizens or aliens who have a legal right to work and remain permanently in the U.S. are eligible
for employment. Can you, after employment, submit verification of your legal right to work in the United
States?
Yes No
Are you a present or former Maine State employee? Yes No (If yes, provide last Department
worked)
Department
Job Title
Begin Date
End Date
Do you have a current Maine driver’s license? Yes No
If yes, what type? Class A Class B Class C
Are you willing to travel on the job? Yes No
If yes, are you willing to use your own vehicle? Yes No
Are you willing to work: Saturdays Sundays Holidays
Are you willing to work overtime? Yes No What shifts are you willing to work? 1
st
2
nd
3
rd
FOREIGN LANGUAGE SKILLS
Language
Speak
Read
Write
Language
Speak
Read
Write
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State of Maine Employment Application PDF

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