This is an accessible web version of the Town's PDF application. The wording is reproduced exactly as published, including "each questions," "Supervisors' Name" and the sentence "Are you a lawful alien authorized for employment?", which runs on from the previous sentence in the original. The original lays out the education, reference, employment and yes/no sections as boxed grids; they are shown here as tables with the same headings. The "Employer Section" at the end is blank in the original. Curly apostrophes are shown as straight ones. To apply, print the original PDF and complete it.
TOWN OF SAND LAKE
Employment Application
POSITION APPLIED FOR:
APPLICANT TELEPHONE:
APPLICANT EMAIL ADDRESS:
LAST FIRST MIDDLE
ADDRESS:
I AM SEEKING A PERMANENT POSITION: Yes No
Are you able to perform the essential functions of the position without accommodations?
Yes No
NYS DRIVERS LICENSE #
EDUCATION:
| School | Yrs. Completed | Field of Study | Graduate or Degree |
|---|---|---|---|
| High School | |||
| College/University | |||
| Business/Technical | |||
| Other (May include grammar school) |
MILITARY SERVICE: Yes No
Duty/Specialized Training:
REFERENCES: List two personal references who are not relatives
| Name | Address | Telephone | Occupation | Years known |
|---|---|---|---|---|
EMPLOYMENT: List last employment first. Include summer or temporary Jobs.
Be sure all your experience or employers related to this job are listed here, in the summary (following this section), or use an extra sheet of paper if necessary.
| Employer Name and Address | Position Title/Duties Skills | Supervisors' Name | Telephone | Dates Employed from | to | Reason for Leaving |
|---|---|---|---|---|---|---|
Types of computers or other equipment that you are qualified to operate or repair:
Professional licenses, Certifications or Registration:
Please check appropriate box to the right of each questions:
| Question | Yes | No |
|---|---|---|
| A) Were you ever dismissed or discharged from any employment for reasons other than lack of work or funds? | ||
| B) Have you ever received a Dishonorable Discharge from the Armed Forces of the United States? | ||
| C) Have you ever been convicted of any crime (felony or misdemeanor)? | ||
| D) Are you now under charges for any crime? |
If you answered "Yes" to any of the questions A-D above, attach an additional sheet giving complete details Are you a lawful alien authorized for employment?
In case of accident or illness please contact:
I agree and authorize the Town of Sand Lake to investigate all areas of my employment background in connection with my application for employment. I understand that reports which may contain public record information may be requested, including criminal records, driving records; education; prior employer verification and others. These reports may include experience along with reasons for termination of past employment.
If necessary for employment, I understand that I may be required to have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms.
I understand and agree with the information shown above, and I affirm that the statements made on this application (including any attached papers) are true, and correct.
Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no effect on your application for employment.
Employer Section:
Source: Employment_Application(1).pdf on townofsandlake.us, linked from the Town Employment Applications page. Copied November 11, 2026.