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East NewarkGreen Risk

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Employment Application

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Executive Summary

This document is an employment application for the Borough of East Newark, located at 34 Sherman Avenue, East Newark, New Jersey 07029. It collects standard applicant information such as name, address, contact details, education, employment history, and references. The application also includes sections for voluntary EEO information and notes for interviewers.

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Document Text

--- Document: Employment Application Document ---
APPLICATION FOR EMPLOYMENT
BOROUGH OF EAST NEWARK
34 Sherman Avenue
East Newark, New Jersey 07029
Phone (973) 481-2902 * Fax (973) 481-0629
www.boroughofeastnewark.com
FOR OFFICIAL USE ONLY
Date Rec'd
Department
Interview
Yes
No
Date:
APPLICATION INFORMATION
Full name (First, Middle, Last)
Present Address (Street, Town, State, Zip)
Home Telephone #
Social Security #
Mobile Telephone #
E-Mail Address
Yes
No
Drivers License Number:
Are you legally eligible for employment in the United State:
(Proof of citizenship or authorization to work in the United States will be required upon hire)
Position(s) applying for:
Were you previously employed by us?
Yes
No If yes, when?
If your application is considered favorably, on
What date wil. you be available to start work?
Do you have any qualifications which will be of benefit in the position for which you are applying?
Is any member of your immediate family employed by the Borough of East Newark?
Where you in the Armed Forces?
Dates of Duty:
From:
Yes
No If yes, please name:
Yes
No
If yes, what branch?
to
Rank at discharge:
If employed by the Borough of East Newark are you willing to take an exam?
Are you available to work Saturdays, Sundays or evenings if required by your position?
RECORD OF EDUCATION
Elementary School
High School
Yes
Yes
No
No
College
Other
School Name
Location
Last Year Completed?
5678
Did you Graduate?
Yes No
9 10 11 12
Yes No
1234
Yes No
Specify Degree or
Certification Received
Yes No
Use this space to describe any internships, licenses, certifications or registrations that you possess which are related to the position for which you are applying?
What type of license(s), certification(s) and/or registration(s) do you hold?
In which state(s) do you hold license(s), certification(s) and/or registration(s)?
What were the original issue date of the license(s), certification(s) and/or registration(s)?
What is the date of your current license(s), certification(s) and/or registration(s)?
What type of internship(s) have you completed?
Where were the internship(s) completed?
What were the dates of the internships?
How many hours per week did you take part in the internship?
Was it part of the college curriculum? Yes No
1
Employment History (start with your current or most recent job)
Employer # 1
Employer # 2
Employer # 3
Name of Company
Address
Job Title
Employment Dates
Work performed
Reason for leaving
Name of Company
Address
Job Title
Employment Dates
Work performed
Reason for leaving
Name of Company
Address
Job Title
Employment Dates
Work performed
Reason for leaving
Type of Business
Telephone Number
Supervisor
Type of Business
Telephone Number
Supervisor
Type of Business
Telephone Number
Supervisor
Is there a particular employer you do not wish us to contact, please indicate which one(s)?
Personal References (no former employers or relatives, please)
Name
Address
1
2
3
Telephone #
The Borough of East Newark is an equal opportunity employer and may not discriminate on the basis of race, color, creed, national origin, ancestry,
political affiliation, age, marital status, sex, civil union status, domestic partnership status, familial status, genetic information, refusal to submit to a
genetic test or make available the results of a genetic test, atypical heredity cellular or blood trait, pregnancy or any other protected status, affectional
or sexual orientation, physical or mental disability, liability for military service or handicap.
All applicants offered a position with the Borough of East Newark must submit to a drug and alcohol test as a condition of employment.
Applicant's Statement
I hereby authorize the Borough of East Newark to contact, obtain and verify the accuracy of information contained in this application from all previous
employers (except where I have indicated they may not be contacted), educational institutions and references. I also hereby release the Borough of
East Newark and its representatives from all liability for seeking, gathering and using such information to make employment decisions and all other
persons or organizations for providing such information.
I certify that the facts set forth in my application for employment are true and complete. I understand that if employed, any false statement on the
application may result in my dismissal. I further understand that this application is not nor is it intended to be a contract of employment, nor does
this application obligate the Borough of East Newark in any way if the Borough decides to employ me.
Signature of Applicant:
2
Date:
EEO VOLUNTARY INFORMATION – BOROUGH OF EAST NEWARK
We consider all applicants for positions without regard to race, religion, sex, national origin, citizenship age, mental or physical disabilities,
veteran/reserve/national guard, or any similarly protected status. We also comply with all applicable laws governing employment practices and do
not discriminate on the basis of any unlawful criteria.
Applicants are not required to provide the following information but may do so on a voluntary basis. The information sought shall not be used in
decisions regarding the hiring of qualified applicants on the basis of race, color, religion, sex, national origin, sexual orientation, age, citizenship, or
mental or physical disabilities.
PLEASE PRINT
Position(s) applied for
Referral Source
Walk in
Employee
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Government Employment Agency
Relative
Name of person who referred you (if applicable)
APPLICANT INFORMATION
Name
LAST
ADDRESS:
Male
STREET
Female
FIRST
CITY
Date
Private Employment Agency
School
Other
Telephone ( ).
MIDDLE
STATE
ZIP CODE
Please check one of the following Equal Employment Opportunity Identification Groups:
White (not Hispanic origin)
American Indian/Alaskan Native
Black (not Hispanic origin)
Asian/Pacific Islander
Hispanic
Multiracial (having parents of different races)
THIS IDENTIFICATION GROUP IS RECOGNIZED
ONLY IN THE STATE OF MICHIGAN
For Administrative Use Only
Position(s) applied for:
Other position(s) considered for
Hired
Position Hired for
Yes
Available
Not Available
No
Date
From the EEO job classifications listed below, which one best described the position filled?
Officials and Managers
Professionals
Technicians
Notes
Sales Workers
Office and clerical work
Craft workers (skilled)
Operatives (semi-skilled)
Laborers (unskilled)
Service workers
Completed by:
3
Date:
Interviewer:
Comments:
Name:
Department:
FOR INTERVIEWERS USE
Date:
REFERENCE CHECK
Comments:
FOR BOROUGH OF EAST NEWARK USE ONLY
(To be completed by Department Head, if applicant is hired)
Title/position for this new employee:
Starting Date:
Hours of Work:
Signature of Department Head:
1797371_1
Full-Time:
Part-Time:
Rate of Pay:
4