EAST AMWELL TOWNSHIP

APPLICATION FOR EMPLOYMENT

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, religion, gender, national origin, age, marital or veteran status, the presence of a non-job related handicap, or any other legally protected status.

PLEASE PRINT

Position Applied For ______________________ Date of Application _____/_____/_____

Name___________________________________________________________________

LAST FIRST MIDDLE

Address_________________________________________________________________

STREET CITY STATE ZIP

Telephone (_____)_____________________ Social Security Number______-_____-______

If you are under 18, can you furnish a work permit? ____________Yes __________No

Have you ever been employed here before? __________Yes _______Year(s) ________No

If related to anyone in our employ, state name and position.__________________________

Are you legally eligible for employment in this country? _______Yes _______ No (Proof of US Citizenship or immigration will be required upon employment.)

Date available for work:___/___/___Type of employment desired: ___Full Time ___Part Time

Are you able to meet the attendance requirements of the position? _______Yes _____No

Have you been convicted of a felony in the past seven (7) years? ______Yes _____ No (Such conviction may be relevant if job related, but does not bar you from employment.) If YES, please explain:________

_____________________________________________________________________________

EMPLOYMENT HISTORY List your last three (3) employers, assignments, or volunteer activities, starting with the most recent, including military experience.

From To	Employer Phone:
Job Title	Address
Immediate Supervisor	Job Summary
Reason for Leaving

REV. 10-07

From To	Employer Phone:
Job Title	Address
Immediate Supervisor	Job Summary
Reason for Leaving

From To	Employer Phone:
Job Title	Address
Immediate Supervisor	Job Summary
Reason for Leaving

SKILLS AND QUALIFICATIONS: Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work in East Amwell Township.

______________________________________________________________________________

__________________________________________________________________________

EDUCATIONAL BACKGROUND:

NAME AND LOCATION

YEARS COMPLETED

COURSE OF STUDY

REFERENCES:

NAME/ADDRESS

TELEPHONE

YEARS KNOWN

IN CASE OF EMERGENCY NOTIFY: Name___________________________ Phone_____________________

It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and for separation from the employer’s service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary.

I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. I HAVE READ AND UNDERSTAND THE ABOVE.

Signature of Applicant: ______________________________________________ Date______________________________

Mail Completed Applications to:

Township Administrator Timothy L. Matheny

East Amwell Township

1070 Route 202/31

Ringoes, New Jersey 08551

Questions should be directed to the Municipal Clerk at tstahl@eastamwelltownship.com

Telephone: 908:782-8536

Fax: 908:782-1967