New England Dragway, Inc.
Employment Application

Applicant Information

Last Name First Name M.I. Date
Street Address        Apartment/Unit #  
    City        State       ZIP Code 
Phone:        E-mail Address:  
Date Available:       To   
 Position(s) Applied for - Ticketing  Race Crew/Tech  Food Svc  EMT/Firefighter  Security
                     Maintenance (Maintenance position is for 5 days a week plus some weekends)
Days Available To Work -  Wed Day  Wed Night  Friday Night  Saturday  Sunday  Major Events Only
Are you a citizen of the United States? If no, are you authorized to work in the U.S.?
Have you ever worked for this company? If yes, when?
Have you ever been convicted of a felony? If yes, explain: 

Education (check last year completed)

Elementary School:  5  6  7  8 - High School : 1  2  3  4
College: 1  2  3  4 Did you graduate? Degree:
College: Address:
Other Training: Address:
From: To: Describe Training:

Present & Previous Employment

Company Phone
Address Supervisor
Job Title May we contact your previous supervisor for a reference
Responsibilities
From To Reason for leaving
Company Phone
Address Supervisor
Job Title May we contact your previous supervisor for a reference
Responsibilities
From To Reason for leaving

Military Service

Branch: From:
To:  
Rank at Discharge: Type of Discharge:
If other than honorable, explain:

Disclaimer and Signature

The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on this application may result in my dismissal. I further understand that this application is not and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me. I understand and agree that my employment is at-will and can be terminated by either party with or without notice, at any time, for any reason or no reason. No one other than an officer of the Company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in writing signed by an officer. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit agencies or bureaus of your choice. In making this application for employment I authorize you to make an investigative consumer report whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry, if made, may include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of any such investigative report that is made.
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I Agree   

READ THIS CAREFULLY BEFORE ANSWERING

To applicant: READ THIS INTRODUCTION CAREFULLY BEFORE ANSWERING ANY QUESTIONS IN THIS BLOCKED-OFF AREA: The Civil Rights Act of 1984 prohibits discrimination in employment because of race, color, creed, religion, sex or national origin. Federal law also prohibits other types of discrimination such as age and citizenship. The laws of most States also prohibit some or all of the above types of discrimination as well as some additional types such as discrimination based upon ancestry, marital status or physical or mental handicap or disability. The Fair Credit Reporting Act imposes restrictions with respect to credit data.

DO NOT ANSWER ANY QUESTION CONTAINED IN THIS BOCKED-OFF AREA UNLESS IT IS IN THE SECTION FOR THE POSITION FOR WHICH YOU ARE APPLYING, thereby indicating that for the position for which you are applying the requested information is needed for a legally permissible reason, including, without limitation, national security requirements, a bona fide occupational qualification or business necessity.

Maintenance: Firefighter/EMT:
Are you over the age of eighteen?  Yes     No Are you over the age of eighteen?  Yes    No
Are you physically able to lift 70 lbs?  Yes      No Are you a certified NH Firefighter?  Yes    No
Are you a nationally registered EMT?  Yes     No