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TOWNSHIP OF DENNIS
571 PETERSBURG ROAD, PO BOX 204
DENNISVILLE, NJ 08214
WWW.DENNISTWP.ORG (609)861-9700
EMPLOYMENT APPLICATION
Please be advised that background checks will be conducted.
Position(s) applied for: ___________________________________________________________________
Name: __________________________________________________________________________________
Address: ________________________________________________________________________________
Home Phone: _________________________________
Cell Phone: ________________________
Email Address: ___________________________________________________________________________
Are you over the age of 18?
Yes
No
If No, can you provide proof of eligibility to work?
Yes
No
Are you a citizen of the United States?
Yes
No
Are you prevented from lawfully becoming employed in this Country because of Visa or
Immigration Status? (proof of citizenship or immigration status will be required)
Yes
No
Have you ever filed an application with the Township before?
Yes
No
If Yes, when & what position? ______________________________________________________
Have you ever been employed by the township before?
Yes
No
If Yes, when & what position? ______________________________________________________
Have you ever been bonded?
Yes
No
If Yes, at what job(s)? _____________________________________________________________
Are you currently employed?
Yes
No
If Yes, may we contact your employer?
Yes
No
On what date would you be available to begin work? ___________________________________
What type of work are you available for?
Full Time
Part Time
Seasonal
Temp
Are you currently on layoff status?
Yes
No
If Yes, are you subject to recall?
Yes
No
What method of transportation will you use to get to work? ________________________________
EMPLOYMENT APPLICATION
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
Have you ever been convicted of a crime, excluding misdemeanors and summary of
offences?
Yes
No
If Yes, please describe in full: ______________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
List any friends or relatives currently or previously employed by the Township: _______________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Name of most recent employer: __________________________________________________________
Address: ________________________________________________________________________________
Job Title: ________________________________________________________________________________
Date Started: _____________________________ Date ended: _________________________________
Annual Salary or Hourly Wage: ___________________________________________________________
Reason for leaving: ______________________________________________________________________
__________________________________________________________________________________________
Name of previous employer: _____________________________________________________________
Address: ________________________________________________________________________________
Job Title: ________________________________________________________________________________
Date Started: _____________________________ Date ended: _________________________________
Annual Salary or Hourly Wage: ___________________________________________________________
Reason for leaving: ______________________________________________________________________
__________________________________________________________________________________________
Name of previous employer: _____________________________________________________________
Address: ________________________________________________________________________________
Job Title: ________________________________________________________________________________
Date Started: _____________________________ Date ended: _________________________________
Annual Salary or Hourly Wage: ___________________________________________________________
Reason for leaving: ______________________________________________________________________
EMPLOYMENT APPLICATION
Please list at least three Personal References (DO NOT list relatives)
Name: __________________________________________________________________________________
Address: ________________________________________________________________________________
Occupation: ________________________________________ Phone: ____________________________
__________________________________________________________________________________________
Name: __________________________________________________________________________________
Address: _________________________________________________________________________________
Occupation: ________________________________________ Phone: ____________________________
__________________________________________________________________________________________
Name: __________________________________________________________________________________
Address: ________________________________________________________________________________
Occupation: ________________________________________ Phone: ____________________________
__________________________________________________________________________________________
Please list any Professional, Business or Civic Activities (include certifications and professional
designations): ___________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
You may exclude membership(s) which would reveal gender, race, religion,
national origin, age, ancestry, disability, or other protected status.
__________________________________________________________________________________________
Signature of Applicant: _________________________________
Date: _________________
If under 18 years of age, Signature of Parent/Guardian: ____________________________________
__________________________________________________________________________________________
FOR TOWNSHIP USE ONLY
Application Received by: _________________________________________ Date: _________________