††††† APPLICATION FOR EMPLOYMENT

Administration Building:One Collyer Lane, Basking Ridge, NJ07920†† Fax 908-204-3015

 

††††††††††††††††††††††††††††††††††† ††Application Date:†††††††††††††††††††††††††††††††††††

 

 

Name:†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

Position Applied For:†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

Department:†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

Building Location:

†† †††† Administration Building- One Collyer Lane

†† †††† Police Building - One Collyer Lane

†† †††† Engineering Services Building Ė 277 South Maple Avenue

†† †††† Health Department - 262 South Finley Avenue

†† †††† Bernards Township Library - 32 South Maple Avenue

†† †††† Bernards Township Sewerage Authority Plant Ė 726 Martinsville Road

 

 

The Township of Bernards considers applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, handicap or disability, sexual orientation, domestic partnership or any other legally protected status.

 

 

A Resume is not a substitute for completing this form in its entirety.

 

 

All information will be verified and all references will be checked.Information will be kept confidential to the extent permitted by law.††

 

 

 

DO NOT WRITE BELOW THIS LINE

 

RECOMMEND FOR EMPLOYMENT:Yes††† No†††††† IF NO, HOLD FOR FUTURE USE?††† Yes††††† No

 

IF YES, START DATE:††††††††††††††††††††††††††††††††††††††††† ††††††††††† START SALARY:†††††††††††††††††††††††††††††††††††††††††††††††††† †††††††††††

HUMAN RESOURCES SIGNATURE:††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††DATE:††††††††††††††††††††††† †††††††††††

 

 

 

 

†††††††††††††††

PLEASE PRINT

I.†† PERSONAL

LAST NAME†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† FIRST††††††††††††††††††††††††††††††††††††††††††††††††††††† MIDDLE

 

 

PRESENT ADDRESS (NUMBER, STREET, CITY, STATE , ZIP CODE)

 

TELEPHONE NUMBER

PERMANENT ADDRESS (IF DIFFERENT THAN PRESENT ADDRESS)

 

TELEPHONE NUMBER

ARE YOU 18 YEARS OF AGE OR OLDER? (If no, you will be required to show proof of eligibility to work.)

Yes†††††††† No

ARE YOU LEGALLY ELIGIBLE TO WORK IN THE UNITED STATES? (Proof of US Citizenship or work authorization status will be required upon employment)

Yes†††††††† No

NAME OF RELATIVE OR FRIENDS EMPLOYED BY BERNARDS TOWNSHIP

 

 

HAVE YOU EVER BEEN EMPLOYED BY BERNARDS TOWNSHIP?††††††† IF YES, STATE WHEN.

 

Yes†††††††† No

HAVE YOU EVER BEEN CONVICTED OF A CRIME, including misdemeanors and summary offenses, which has not been sealed or otherwise cleared from your record?IF YES, EXPLAIN INCLUDING PERIODS OF REHABILITATION.(A yes answer is not an automatic bar to employment.)

 

Yes†††††††† No

 

II.POSITION AND PERSONAL INTERESTS

POSITION APPLIED FOR

TITLE

 

SALARY DESIRED

$†††††††††††††††††††††††††††† PER†††††††

ARE YOU EMPLOYED NOW?

Yes†††††††† No

DATE AVAILABLE TO START WORK

HOW WERE YOU REFERRED TO US?

WHAT KIND OF WORK DO YOU GENERALLY PREFER?(INTERESTS AND CAREER OBJECTIVES)

 

COMPLETE IF DRIVING IS AN ESSENTIAL PART OF THE JOB BEING APPLIED FOR

DO YOU HAVE A VALID DRIVERíS LICENSE?†††† Yes†††††††† No

PLEASE SIGN TO INDICATE YOUR AUTHORIZATION FOR THE TOWNSHIP TO PERFORM A RECORD CHECK OF THE DIVISION OF MOTOR VEHICLESí FILES, UPON AN OFFER OF EMPLOYMENT BY THE TOWNSHIP:

 

III.EDUCATION AND TRAINING

 

SCHOOL

 

NAME AND ADDRESS OF SCHOOL

COURSE OF STUDY

CIRCLE LAST YEAR COMPLETED

DID YOU GRADUATE?

LIST DIPLOMA OR DEGREE

HIGH SCHOOL

OR EQUIVALENT

 

 

 

9†† 1011†† 12

Yes†††††††† No

 

TECHNICAL OR

COMMERCIAL

 

 

 

1††† 2††† 3†††† 4

Yes†††††††† No

 

 

COLLEGE

 

 

 

1††† 2††† 3†††† 4

Yes†††††††† No

 

OTHER

(SPECIFY)

 

 

 

1††† 2††† 3†††† 4

Yes†††††††† No

 

ARE YOU TAKING ANY COURSE OF STUDY NOW?†††† IF YES, PROVIDE DETAILS:

††††††† Yes†††††††† No

DATE TO BE COMPLETED

 

 

LIST ANY SCHOLASTIC HONORS, HONORARY SOCIETIES, FELLOWSHIPS AND SCHOLARSHIPS.

 

 

DESCRIBE ANY SPECIALIZED TRAINING, APPRENTICESHIP, SKILLS OR EXTRA-CURRICULAR ACTIVITIES (i.e. EMT or fire fighting training and participation, etc.)Exclude those that indicate race, religion, sex, age, national origin or other protected classification.

 

IF YOU HAVE EMT OR FIRE FIGHTING CERTIFICATION, WOULD YOU BE WILLING TO VOLUNTEER FOR THE TOWNSHIP DURING YOUR WORKDAY?††††† Yes†††† ††No

WHAT COMPUTER SKILLS DO YOU HAVE AND WHAT OFFICE MACHINES CAN YOU USE?(IF APPLICABLE)

 

IV.EMPLOYMENT HISTORY

Please account for all periods of employment, including U.S. Armed Forces experience, periods of travel, and self-employment.List present or last employer first.If more space is desired, please use an additional application.

NAME OF EMPLOYER

ADDRESS OF EMPLOYER

DATE EMPLOYED

†††††††††† FROM††††††††††††††††††††††††††† TO

†††††††††† /††††††††††††††††††† /††

†† MONTH†††† YEAR†††††††††† MONTH†††† YEAR

TELEPHONE OF EMPLOYER

SUPERVISORíS NAME & TITLE

DEPARTMENT

 

 

YOUR POSITION OR TITLE:††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† REASON FOR LEAVING:

MAY WE CONTACT EMPLOYER?†††††††††††† NOW[††† ]††††††††††††††††††††††††††††††††† AT A LATER DATE†† [††† ]†††††††††††††† †††††††††††††††NOT AT ALL†† [††† ]

 

 

NAME OF EMPLOYER

ADDRESS OF EMPLOYER

DATE EMPLOYED

†††††††††† FROM†††††††††††††††††††††††††† TO

†††††††††† /†††††††††††††††††† /††

†† MONTH†† YEAR††††††††††† MONTH†† YEAR

TELEPHONE OF EMPLOYER

SUPERVISORíS NAME & TITLE

DEPARTMENT

 

 

YOUR POSITION OR TITLE:††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† REASON FOR LEAVING:

MAY WE CONTACT EMPLOYER?††††††††††††† NOW[††† ]††††††††††††††††††††††††††††††††† AT A LATER DATE†† [††† ]††††††††††††††††††††††††††††† NOT AT ALL†† [††† ]

 

 

NAME OF EMPLOYER

ADDRESS OF EMPLOYER

DATE EMPLOYED

†††††††††† FROM††††††††††††††††††††††††† TO

†††††††††† /†††††††††††††††††† /††

†† MONTH†† YEAR††††††††††† MONTH†† YEAR

TELEPHONE OF EMPLOYER

SUPERVISORíS NAME & TITLE

DEPARTMENT

 

 

YOUR POSITION OR TITLE:††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† REASON FOR LEAVING:

MAY WE CONTACT EMPLOYER?†††††††††††††† NOW[††† ]††††††††††††††††††††††††††††††††† AT A LATER DATE†† [††† ]††††††††††††††††††††††††††††† NOT AT ALL†† [††† ]

 

 

NAME OF EMPLOYER

ADDRESS OF EMPLOYER

DATE EMPLOYED

†††††††††† FROM†††††††††††††††††††††††††† TO

†††††††††† /††††††††††††††††††† /††

†† MONTH†† YEAR††††††††††† MONTH†† YEAR

TELEPHONE OF EMPLOYER

SUPERVISORíS NAME & TITLE

DEPARTMENT

 

 

YOUR POSITION OR TITLE:††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† REASON FOR LEAVING:

MAY WE CONTACT EMPLOYER?††††††††††††††† NOW[††† ]††††††††††††††††††††††††††††††††† AT A LATER DATE†† [††† ]††††††††††††††††††††††††††††† NOT AT ALL†† [††† ]

 

 

NAME OF EMPLOYER

ADDRESS OF EMPLOYER

DATE EMPLOYED

†††††††††† FROM†††††††††††††††††††††††††††† TO

†††††††††† /††††††††††††††††††† /††

†† MONTH†† YEAR††††††††††† MONTH†† YEAR

TELEPHONE OF EMPLOYER

SUPERVISORíS NAME & TITLE

DEPARTMENT

 

 

YOUR POSITION OR TITLE:†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† †††††††††††††††REASON FOR LEAVING:

MAY WE CONTACT EMPLOYER?†††††††††††††† NOW[††† ]††††††††††††††††††††††††††††††††† AT A LATER DATE†† [††† ]††††††††††††††††††††††††††††† NOT AT ALL†† [††† ]

 

 

 

 

V.OUTSIDE ORGANIZATIONS

ARE YOU AFFILIATED WITH ANY OTHER COMPANY THAT REQUIRES WORK OF YOU?

Yes†††††††† No††††††† IF YES, PLEASE EXPLAIN

ARE YOU ENGAGED IN ANY PERSONAL BUSINESS OR ENTERPRISE?

Yes†††††††† No††††††† IF YES, PLEASE EXPLAIN

IN WHAT BUSINESS, PROFESSIONAL OR SCIENTIFIC ASSOCIATIONS DO YOU HOLD MEMBERSHIP?Exclude those that indicate race, religion, sex, age, national origin or other protected classification.

 

 

WHAT PROFESSIONAL LICENSES DO YOU HOLD?

 

 

DESCRIBE ANY OTHER EXPERIENCE THAT MIGHT BE HELPFUL IN CONSIDERING YOUR APPLICATION.(Other work experience, internships, school activity, apprenticeships, etc.)

 

 

 

 

 

VI.REFERENCESExclude relatives but provide three (3) persons not previously mentioned who are most familiar with your

††††††††††††††††††††††††††††††† work, ability and training.

NAME

RELATIONSHIP

POSITION

ADDRESS

TELEPHONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VII.ESSENTIAL FUNCTIONS†††††† Do not answer this question without first reviewing the Job Description

ARE YOU ABLE TO PERFORM THE ESSENTIAL REQUIREMENTS OF THE JOB, WITH OR WITHOUT REASONABLE ACCOMODATION?†††

Yes†††††††† No

 

VIII.RELEASE OF APPLICATION††††††

IF YOU ARE UNSUCCESSFUL IN YOUR CANDIDACY FOR A POSITION WITH THE TOWNSHIP, DO YOU WISH YOUR APPLICATION TO BE DISCLOSED?†††

Yes†††††††† No

 

IX.APPLICANTS STATEMENT
I certify that answers given herein are true and complete to the best of my knowledge.I authorize investigation of all statements contained in this application as may be necessary in arriving at an employment decision.I release former employers and others from any liability that might arise from the disclosure of information.

 

I understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an ďat willĒ nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.

 

I understand that misrepresentation or omission of facts called for is basis for township refusal to process application further or, in the event of employment, cause for dismissal.I fully and completely understand that as a condition of employment, I must be able to perform all the duties of the position applied for.I also understand that if employed, by the township, I must abide by all rules and regulations of the employer.

 

 

Signature of Applicant:†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††† Date:_____________________

 

 

†††††††††††††††