Document Text
--- Document: Employment Application Document ---
Township of Burlington Date:
851 Old York Road
Burlington Township, NJ 08016
Employment Application:
Applicant Information:
Name(Last,First,Middle):
Address:
City/Town:
Phone (Home): ( )
(Mobile): ( )_
(Other): (_ )
Email:
Social Security Number:
-
-
Position applied for: _______________________________________________________________
Have you ever applied to the Township of Burlington before: ____ Yes ____No If yes, give
date___________
Date you can start: ______________________ Salary Desired: ________________________
Are you available to work: ____ Full time____ Part time____ Shift work ____ Temporary
Are you currently employed: ____Yes ____No May we contact you at work: ____Yes ____No
May we contact your current employer: ____ Yes ____No
Are you currently on layoff status and subject to recall: ____Yes ____No
Do you possess a current driver’s license: ____Yes ____ No
Do you possess a current commercial driver’s license: _____ Yes _____ No
Please list any endorsements:_________________________________________________
If you are under eighteen years of age, can you provide proof of eligibility to work: ___ Yes __No
Are you legally eligible to work in the United States of America: ____Yes ____ No
Pursuant to Federal Law, proof of US Citizenship or immigration status will be required if you are hired.
The Township of Burlington is an Equal Opportunity Employer M/F
Employment History: This section must be completed even if you attach a resume.
List your last four employers, major assignments within the same employer. Begin with the
most recent. Include any military service. Explain any gaps in employment in the space on
this form marked comments located on the bottom of this page.
Employer:
Address:
Date started: Date left:
Work performed/
responsibilities:
Starting Salary:
Final Salary:
Job Title:
Reason for leaving:
Supervisor’s name and phone number:
May we contact for a reference: ___Yes ___No
Employer:
Address:
Date started: Date left:
Work performed/
responsibilities:
Starting Salary:
Final Salary:
Job Title:
Reason for leaving:
Supervisor’s name and phone number:
May we contact for a reference: ___Yes ___No
Employer:
Address:
Date started: Date left:
Work performed/
responsibilities:
Starting Salary:
Final Salary:
Job Title:
Reason for leaving:
Supervisor’s name and phone number:
May we contact for a reference: ___Yes ___No
Employer:
Address:
Date started: Date left:
Work performed/
responsibilities:
Starting Salary:
Final Salary:
Job Title:
Reason for leaving:
Supervisor’s name and phone number:
May we contact for a reference: ___Yes ___No
Comments:
Education: Provide information on your formal schooling and education. Include
elementary, secondary, and post-secondary education, if any. Include any formal
vocational or professional education. For high school and post-secondary education,
indicate any major or specialty, such as Academic, Business, or Trade.
School:
Years completed:
(Circle)
Graduated:
(Circle)
Major Field:
High:
1 2 3 4
Yes No
College:
1 2 3 4
Yes No
Other:
1 2 3 4
Yes No
Languages: List any foreign languages you know and indicate your level of proficiency.
Language:
Speak Some:
Speak Fluently:
Read:
Write:
Special Skills & Experience: State any special skills, experience, training, licenses,
certifications or other factors that make you especially qualified for the position for which
you are applying.
Comments & Additional Information: Is there any additional information
about you we should consider?
References: Provide the names, addresses and phone numbers of three people whom we
may contact as a reference. They should not be relatives or former supervisors.
Name & Address:
Phone Number:
Years Known:
Understandings and Agreements:
As an applicant for a position with the Township of Burlington, I understand and agree that
I must provide truthful and accurate information in this application. I understand that my
application may be rejected if any information is not complete, true and accurate. If hired,
I understand that I may be separated from employment if the Township of Burlington later
discovers that information on this form was incomplete, untrue, or inaccurate. I give the
Township of Burlington the right to investigate the information I have provided, talk with
former employers (except where I have indicated they may not be contacted). I give the
Township of Burlington the right to secure additional job-related information about me. I
release the Township of Burlington and its representatives from all liability for seeking such
information. I understand that the Township of Burlington is an equal-opportunity
employer and does not discriminate in its hiring practices. I understand that the Township
of Burlington will make reasonable accommodations as required by the Americans with
Disabilities Act. I understand that, if employed, I may resign at any time and that the
Township of Burlington may terminate me at any time in accordance with its established
policies and procedures. No representatives of the Township of Burlington may make any
assurances to the contrary. I understand that any offer of employment may be subject to
job-related medical, physical, drug, or psychological tests. I also understand that some
positions may involve complete background and criminal checks. For your application to be
considered, you must sign and date below.
Applicant’s Signature
Date
SIGN