LSNJ Employment Application General
General Information
What position would you like to apply for?
*
Salary Desired
Where did you hear of the position?
Name
*
First Name
Last Name
Pronouns - select one or more options below for the set(s) of pronouns you would like us to use when referring to you.
*
He, him, his
She, her, hers
They, them, theirs
Other
EMAIL:
*
example@example.com
PHONE NUMBER
*
Please enter a valid phone number.
Format: (000) 000-0000.
ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Note: All prospective employees must submit proof of identity and eligibility for employment in the U.S. prior to appointment.
Are you legally eligible to work in the U.S.?
*
Yes
No
Please list any restrictions on your eligibility for employment imposed by United States Immigration Law.
Have you ever served in the military service?
*
Yes
No
Military Service Information
Have you ever worked for LSNJ?
*
Yes
No
LSNJ previous employment
Do you have a driver’s license?For some LSNJ positions, driver’s license and access to a motor vehicle will be necessary.
*
Yes
No
Have you ever been fired or asked to resign from a job?
*
Yes
No
If yes, give the name and address of employer and describe reason. A firing or forced resignation does not automatically exclude you from employment.
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Education Information
Please enter the information pertinent to your education level.
Name and location of the last high school attended:
Did you graduate high school? *
*
Yes
No
If not, have you passed a G.E.D. test?
*
Yes
No
College/Post Graduate - Please enter “n/a” in any unused rows below
*
Rows
School Name
Major Area of Study
Degree
Cumulative GPA
1
2
3
4
Special Qualifications and Skills: (foreign languages, professional licenses, certificates, computer skills, typing)
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EXPERIENCE
Job Experience (1)
History
Rows
Dates
Hrs per Week
From
To
Describe your work (1):
Supervisor's Name
Reason for Leaving
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EXPERIENCE
Job Experience (2)
History
Rows
Dates
Hrs per Week
From
To
Describe your work (2):
Supervisor's Name
Reason for Leaving
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EXPERIENCE
Job Experience (3)
History
Rows
Dates
Hrs per Week
From
To
Describe your work (3):
Supervisor's Name
Reason for Leaving
List any activities which have provided you with experience you consider useful for the position in which you are interested or for work on behalf of low-income people?
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References
May we conduct a background check of your qualifications, character and record of employment?
*
Yes
No
No, please explain
Please list 3 professional references, not relatives including past supervisors who can tell us about your qualifications.
*
Rows
Name
Title/Company
Telephone Number
Yrs. Known
1
2
3
This statement must be signed.
By typing my name below, I certify that all of the statements made in this application are true and complete to the best of my knowledge. I understand that a false or incomplete answer may be grounds for dismissing me after I have begun volunteer work. I authorize investigation by LSNJ of all statements contained in this application or made by me during any interviews. I understand that this application will remain active for 60 days only and that I must reapply to be considered for any future openings.
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: