Remains in effect for a period of 90 days. To be considered for employment beyond this time you must re-apply in writing. Please answer all questions: Do not indicate “See Resume,” or include any information not requested. If you prefer to download a printable version of this application and fill out with ink, click here. Personal Data First Name * Middle Initial Last Name * Address * Address Line 2 City * State * AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Telephone Number(s): Best * Other Email Address * How did you learn about us? * Walk-in Advertisement Employment/Search Agency College/Recruiting Friend Employee Other... How did you learn about us? Other... Employee Name * Type of Work Desired Position Applied For * Identify your long-range goal and the work environment you are looking for * Acceptable beginning hourly rate / salary * $ General Information Are you available to work: * Full Time Part Time Shift Work Temporary On what date would you be available for work? * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202420252026 Can you furnish proof of your legal right to work in the United States? * Yes No Proof of citizenship or immigration status will be required upon employment, along with an I-9 form. Are you over 18 years of age? * Yes No If you are under 18 years of age, can you provide required proof of your eligibility to work? * Yes No Have you ever been employed with NEPTUNE TOWNSHIP? * Yes No Start date of prior employment * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 End date of prior employment * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Reason for leaving * Are you currently employed? * Yes No Do you have a valid NJ Driver's License? * Yes No NJ Driver's License # * Do you have a valid NJ Commercial Driver's License? (CDL) * Yes No Class * Endorsements * Educational Data / ReferencesSchool Name High School Undergraduate College/University Graduate/Professional Other School Location High School Undergraduate College/University Graduate/Professional Other Years Completed High School 9 10 11 12 Graduate/Professional 1 2 3 4 Undergraduate College/University 1 2 3 4 Other Diploma/Degree High School Undergraduate College/University Graduate/Professional Other Major/Minor High School Undergraduate College/University Graduate/Professional Other Grade Point Average High School Undergraduate College/University Graduate/Professional Other Describe any academic honors you have received Describe any specialized training, apprenticeship, co-op, and skills References Please provide the names of three people (no relatives) that have known you for at least five (5) years, who can attest to your character, job skills, knowledge and abilities. Reference Name * Address * Occupation * Phone Number * Reference Name * Address * Occupation * Phone Number * Reference Name * Address * Occupation * Phone Number * Reference Name Address Occupation Phone Number Reference Name Address Occupation Phone Number Reference Name Address Occupation Phone Number Military Data Branch of Service Dates of Service Start Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 End Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Have you ever had any job-related training in the United States Military? Yes No If yes, please describe: Special Skills and Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience. Honors and Activities List all honors, civic, social, and professional activities during your school and professional careers. Omit those that indicate race, color, religion, age, sex, national origin, disability, veteran status, genetic information or union membership. Employment Data (Begin with present or most recent position. In listing dates, give month and year.) May we contact your current employer? Yes No Employer Employer Name Email Phone Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Job Title Dates Employed Start Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 End Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Reason for leaving Work Performed Note: If break between jobs, please explain: Employer Employer Name Email Phone Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Job Title Dates Employed Start Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 End Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Reason for leaving Work Performed Note: If break between jobs, please explain: Employer Employer Name Email Phone Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Job Title Dates Employed Start Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 End Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Reason for leaving Work Performed Note: If break between jobs, please explain: Employer Employer Name Email Phone Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Job Title Dates Employed Start Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 End Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Reason for leaving Work Performed Note: If break between jobs, please explain: Equal Opportunity Statement NEPTUNE TOWNSHIP provides equal opportunity to all qualified persons, without regard to race, color, religion, age, sex, national origin, veteran status, disability, genetic information or other legally protected status. Certification and Agreement As an applicant for employment with NEPTUNE TOWNSHIP, I understand that I will be considered to be an "Applicant" only if I have properly completed this application, designated a particular position that is open (or may come open within 90 days) and my background and qualifications meet NEPTUNE TOWNSHIP’s requirements for such position. * I understand that I will be considered to be an "Applicant" only if I have properly completed this application, designated a particular position that is open (or may come open within 90 days) and my background and qualifications meet NEPTUNE TOWNSHIP’s requirements for such position. I certify that all information given on this application and accompanying documentation is true and correct. * I certify that all information given on this application and accompanying documentation is true and correct. I understand that any misrepresentation or falsification of information or material omission will be cause for rejection of my application or for subsequent corrective action or termination of employment if discovered at a later date. * I understand that any misrepresentation or falsification of information or material omission will be cause for rejection of my application or for subsequent corrective action or termination of employment if discovered at a later date. I certify that I have and read and understand NEPTUNE TOWNSHIP’s substance abuse policy and that my employment is contingent upon the results of a drug screening analysis for substance abuse. The results of such analysis may be grounds for disqualifying me or terminating my employment. * I certify that I have and read and understand NEPTUNE TOWNSHIP’s substance abuse policy and that my employment is contingent upon the results of a drug screening analysis for substance abuse. The results of such analysis may be grounds for disqualifying me or terminating my employment. If my application for employment is accepted, the effective date of my employment shall be the time I actually begin to work. If I am employed, I agree to comply with and be bound by NEPTUNE TOWNSHIP’s policies, practices, safety, and health rules. * If my application for employment is accepted, the effective date of my employment shall be the time I actually begin to work. If I am employed, I agree to comply with and be bound by NEPTUNE TOWNSHIP’s policies, practices, safety, and health rules. I understand that my employment is not guaranteed for any term and that my employment may be terminated by the company or myself at anytime with or without cause. No management official is authorized to make any oral assurance or promise of continued employment. * I understand that my employment is not guaranteed for any term and that my employment may be terminated by the company or myself at anytime with or without cause. No management official is authorized to make any oral assurance or promise of continued employment. I hereby give NEPTUNE TOWNSHIP the right to make a thorough investigation of my past employment, education, and activities, and release from all liability all persons, companies, corporations and agencies supplying such information. * I hereby give NEPTUNE TOWNSHIP the right to make a thorough investigation of my past employment, education, and activities, and release from all liability all persons, companies, corporations and agencies supplying such information. I indemnify NEPTUNE TOWNSHIP against any liability that might result from making such investigation and acknowledge that the results of any such investigation may be grounds for disqualifying me or terminating my employment. Are you currently disqualified from public employment due to a criminal conviction for which N.J.S.A. 2C:51-2.d applies? * Yes No I have read and fully understand the contents of the Certification and Agreement section. Signature of Applicant * (Type your full name) feed me To prevent automated spam submissions leave this field empty.
