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Application for Employment

Personal Information

First Name

Middle Name

Last Name

Your Email

Street Address

City

County

State Value is not selected

Zip Code

Telephone Number

List other vehicular licenses you now hold.

Military Service (Branch and Dates Served)

Are you eligible to work in the U.S.?

Yes

No

If you are under 18 years of age, can you provide proof of your eligibility to work?

Yes

No

Employment Desired

Position

Salary Desired

Date Available

Have you ever applied to the Township of Wayne before?

Yes

No

Have you ever been employed by the Township of Wayne before?

Yes

No

When?

Education

Select the highest grade completed. Value is not selected

List any trade schools, colleges, universities, or graduate schools you have attended. Include any apprenticeships.

Name of School

Major

Graduated

Degree / License

Add Another School

Name of School

Major

Graduated

Degree / License

Add Another School

Name of School

Major

Graduated

Degree / License

Add Another School

Name of School

Major

Graduated

Degree / License

Special Skills

Summarize special job related skiils and qualifications that might be helpful in considering your application.

List title and license number of any N.J. state professional licenses you now hold.

Employment Experience

From: Month Present or Most Recent Employer Value is not selected

From: Month Past Employer 1 Value is not selected

From: Month Past Employer 2 Value is not selected

From: Year Present or Most Recent Employer

From: Year Past Employer 1

From: Year Past Employer 2

To: Month Present or Most Recent Employer Value is not selected

To: Month Past Employer 1 Value is not selected

To: Month Past Employer 2 Value is not selected

To: Year Present or Most Recent Employer

To: Year Past Employer 1

To: Year Past Employer 2

Name Present or Most Recent Employer

Name Past Employer 1

Name Past Employer 2

Address Present or Most Recent Employer

Address Past Employer 1

Address Past Employer 2

Telephone Present or Most Recent Employer

Telephone Past Employer 1

Telephone Past Employer 2

Position Present or Most Recent Employer

Position Past Employer 1

Position Past Employer 2

Reason For Leaving Present or Most Recent Employer

Reason For Leaving Past Employer 1

Reason For Leaving Past Employer 2

May we contact your present employer?

Yes

No

References

Give name, address, and telephone number of three references who are not related to you and are not former employees.

Name

Address

Telephone

Add Another Reference

Name

Address

Telephone

Add Another Reference

Name

Address

Telephone

Voluntary Affirmative Action Information

Wayne Township takes pride in being an equal opportunity employer. As such, we are required to maintain certain applicant information in accordance with government regulations. Our employment decisions are made without regard to race, color, religion, sex, national origin, age, disability or veteran status.

To comply with Wayne Township's Affirmative Action record keeping and reporting obligations, we ask your cooperation in completing this "Applicant Data Form." You may be assured that the form will be kept separate from your employment application and that your employment opportunity with Wayne Township will depend solely on your qualifications.

Completion of this form is optional on your part, but your cooperation in providing this information will be greatly appreciated.

I prefer not to provide this information.

First Name

Middle Name

Last Name

Street Address

City

County

State

Zip Code

Telephone

Position applied for

Sex Value is not selected

Ethnicity Value is not selected

What influenced you to apply for employment with Wayne Township?

Walk In

Referral

Agency

Other

Referral

Agency

Other

Pre-employment Statement

I hereby certify that the foregoing statements made by me are true and complete and authorize the investigation by the Township of Wayne as to their accuracy and completeness. I understand that the misrepresentation or omission of any facts will subject me to disqualification from employment and / or dismissal.

As a condition of employment, I consent to a medical examination by a physician designated by the Township of Wayne. I understand that said medical examination may include both drug and alcohol testing and that any offer of employment by the Township is contingent upon satisfactory results of the medical examination. I agree to resubmit to any future examinations as required and further agree to comply with all Township work, health, safety and general rules and regulations. All successful applicants for employment shall be fingerprinted and photographed, in accordance with Chapter 4, Article XX, section 4-68(c) of the Code of the Township of Wayne.

I authorize the release from all courts, probation departments, employers, present and former and other institutions and agencies without exception, any and all information, documentary or otherwise pertaining to me, that may be requested by the Township of Wayne or its representatives. A photostatic copy of this authorization will be considered as effective and valid as the original. Wayne Township is an Equal Opportunity Employer and no question on this application is used to limit or exempt any applicant from consideration for employment on a basis prohibited by applicable laws.

IMPORTANT!! This application for employment will be considered incomplete if it has not been signed and dated.

Completed By

Date

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Wayne Township Job Application

Personal Information

Employment Desired

Education

Special Skills

Employment Experience

References

Voluntary Affirmative Action Information

Pre-employment Statement