SJS Employment Application Form

Position Applying For*

Personal Information:

Name:*

First NameMiddle NameLast Name

Are you at least 18 years of age?*

YesNo

Phone Number:*

Area CodePhone Number

E-mail Address:*

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Besides English, list any other languages you speak fluently.

Employment Eligibility:

Are you legally authorized to work in the United States?*

YesNo

Do you now, or will you, later on, require sponsorship for employment visa status to legally work for our company in the United States?*

YesNo

Have you ever been convicted of a crime?*

YesNo

If yes, please explain:

Do you have any pending criminal charges against you?*

YesNo

If yes, please explain:

Do you consent to a background check?*

YesNo

Education History:

Highschool:

Highschool:*

City/State:*

Start Date:*

End Date:*

Did you graduate?*

YesNo

College:

College/University:

City/State

Field of Study:

Start Date:

End Date:

Did you graduate?

YesNo

If no, do you have at least 30 College Credit Hours?

YesNo

Administrative/Educational Certifications:

Please list any administrative/educational certifications:

Employment History:

Upload Resume:*

Upload a File

Please provide complete full-time and part-time employment for your most recent 3 employers (if applicable) beginning with your current employer or most recent employer.

Current or Most Recent Employer:

Employer:

Position Title:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:

Area CodePhone Number

Start Date:

End Date:

Supervisor Name:

Reason for Leaving (If applicable):

Brief description of job responsibilities:

Employment History Continued:

Employer:

Position Title:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:

Area CodePhone Number

Start Date:

End Date:

Supervisor Name:

Reason for Leaving (If applicable):

Brief description of job responsibilities:

Employment History Continued:

Employer:

Position Title:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:

Area CodePhone Number

Start Date:

End Date:

Supervisor Name:

Reason for Leaving (If applicable):

Brief description of job responsibilities:

Do you give us permission to contact these employers?*

YesNo

References Please provide the following information for 2 professional references. Please no relatives.

Reference 1

Name:

First NameLast Name

Phone Number

Area CodePhone Number

Years Known:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you give us permission to contact this reference?

YesNo

Reference 2

Name:

First NameLast Name

Phone Number

Area CodePhone Number

Years Known:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you give us permission to contact this reference?

YesNo

How were you referred to us?*

EmployeeFlyer PostingSocial MediaOther

Disclaimer:

It is the fundamental policy of South Jersey Solutions not to discriminate because of race, color, religion, sex, marital status, sexual orientation, national origin, age, disability, regarding recruitment, hiring, training, promotion and other conditions of employment.

It is the policy of South Jersey Solutions to base decisions of employment solely on an applicant’s qualifications matching the requirements of the position for which the individual is
being considered.

Applicant Statement:

I certify that the information provided on this application (and any resume attached) is true and complete to the best of my knowledge.

In the event of employment, I understand that false or misleading statements or omission of information given in my application or interview may disqualify me from further consideration for employment and may result in your termination if revealed at a later date. I also agree, if hired to become familiar with the policies, practices, and procedures of South Jersey Solutions.

I further understand that employment with South Jersey Solutions, is voluntarily entered into at will and that I am free to resign at any time. Similarly, South Jersey Solutions is free to terminate my at will employment at any time, with or without cause, unless otherwise prohibited by law.

Signature*