APPLICATION FOR EMPLOYMENT

Administration Building:  One Collyer Lane, Basking Ridge, NJ  07920   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 – 277 South Maple Avenue

        Health Department - 262 South Finley Avenue

        Bernards Township Library - 32 South Maple Avenue

        Bernards Township Sewerage Authority Plant – 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 DRIVER’S LICENSE?      Yes          No

PLEASE SIGN TO INDICATE YOUR AUTHORIZATION FOR THE TOWNSHIP TO PERFORM A RECORD CHECK OF THE DIVISION OF MOTOR VEHICLES’ 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   10  11   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

SUPERVISOR’S 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

SUPERVISOR’S 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

SUPERVISOR’S 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

SUPERVISOR’S 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

SUPERVISOR’S 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.  REFERENCES  Exclude 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 “at will” 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:  _____________________