Employment Application

Borough of Prospect Park

106 Brown Ave. Prospect Park, NJ 07508

Date

Name

First Name Middle Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone: (Cell)

(Home)

Date of Birth

Date

Social Security #

Position(s) applying for

Have you ever applied/worked for the Borough before?

Yes No

Date you can start:

Date

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

DL #

Do you possess a current commercial driver’s license

Yes No

Please list any endorsements

Are you 18 years of age, and if so can you provide proof of eligibility to work?

Yes No

Are you legally eligible to work in the USA?

Yes No

(Pursuant to Federal Law, proof of US Citizenship or immigration status will be required if you are hired.)

Have you ever pleaded guilty or been found guilty of a crime or disorderly persons offense:

Yes No

Employment is conditional upon the results of the criminal backgrounds check. An answer of “yes” may disqualify you from employment depending upon the circumstances involved. If “yes” please explain below:

Yes No

Please explain

COMMENTS

Previous Employment

Employer

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities:

From

Date

To

Date

Reason for Leaving

May we contact your reference?

Yes No

Employer

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities:

From

Date

To

Date

Reason for Leaving

May we contact your reference?

Yes No

Employer

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities:

From

Date

To

Date

Reason for Leaving

May we contact your reference?

Yes No

Branch

From

Date

To

Date

Rank at Discharge

Type of Discharge

If other than honorable, explain

COMMENTS

	Years Completed	Graduated	Major Field
School
High
College
Other

Languages: List any foreign Languages you know and indicate your level of proficiency.

	Language:	Speak Some:	Speak Fluently:	Read:	Write:
1
2
3

Type a 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?

As an applicant for a position with the Borough of Prospect Park, 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 Borough later discovers that the information on this form was incomplete, untrue or inaccurate. I give the Borough of Prospect Park the right to investigate the information I have provided, take with former employers (except where I have indicated they may not be contacted). I give the Borough of Prospect Park the right to secure additional job-related information about me. I release the Borough of Prospect Park and its representative from al liability for seeking such information. I understand that the Borough of Prospect Park is an equal-opportunity employer and does not discriminate in its hiring process. I understand that the Borough of Prospect Park will make reasonable accommodations as required by the Americans with the Disabilities Act. I understand that if employed, I may resign at any time and that the Borough of Prospect Park may terminate me at any time in accordance with its established policies and procedures. No representative of the Borough of Prospect Park may make any assurances to the contrary. I understand that any offer of employment may be subjected 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 complete you must sign and date below.

Applicant's Signature

Date

Employment Application

Employment History

Military Service

Education