Pre-Employment Application

To establish a complete pre-employment file, please complete and submit this application.  Your application will be retained in active status for one year.  If your qualifications match our needs, we will contact you for further information and a possible interview.

Date

Last Name

First Name

Middle Initial

Address

City

State

Zipcode

Daytime Phone Number

Evening Phone Number

Email

Position Desired

Are you available to work?

Date you can begin to work:

Desired salary:

Do you have any relatives working at Wellmore?
YesNo

Can you travel within Connecticut if the job requires it?
YesNo

Are you legally authorized to work in the United States?
YesNo

What educational degree(s) do you hold?

Do you have any professional certifications/licenses?
YesNo
If yes, please list:

Can you speak and/or read another language other than English?
YesNo
If yes, please list:

Have you ever been involuntarily terminated or asked to resign from any position of employment?
YesNo
If yes, please explain:

Upload Current Resume and Cover Letter
that outlines your education, work experience
and any special skills you possess.