Do you possess any specialized skills, certifications, or licenses that may be applicable to or have relevance for this application?
Arrested?
Have the police ever been called to your home for any reason?
Cell Phone #
For any misdemeanor or felony offense — in any jurisdiction, including under the Uniform Code of Military Justice (UCMJ) — have you EVER been:
Applicant Details
Full Name
If 'Yes', please list all the languages you are proficient in.
If 'Yes', Please type the License #
Are you proficient in any languages other than English?
If you answered 'Yes' to any of the above questions, please provide details
Phone #
Are you 18 or older?
Address 2
ZIP
Do you possess any licenses, permits, or registrations pertaining to the ownership, possession, or use of firearms?
Indicted?
Email
Is your license currently suspended in any state?
If 'Yes,' please list all the specialized skills that you possess.
Address
Convicted?
Do you currently possess a valid NJ Driver's License?
Questioned or detained by law enforcement as part of an investigation (whether as a witness, victim, or person of interest)?
Formally charged?
SSN
City
State
Applicant's Signature
Certification
I have read and understand the above agreement, and I agree to its terms.
Agreement to Hold Harmless and Release From All Liability
Signature
I, the undersigned, hereby release and Hold Harmless the City of Linden, all of its departments, employees, elected and appointed officials from any claim or liability that could arise on my behalf or that of my heirs, or assigns due to any injury, harm, exposure, burn, contamination, short or long term illness, blindness, deafness, dismemberment, mental condition, attack, impaired condition of any sort, any other condition not previously stated or death. I acknowledge that I am totally responsible for all bills/invoices for my health care, emergency care, emergency transportation, emergency medical service, basic and advanced life support emergency services, hospitalization, physicians, nursing, radiological, dental services, restorative services of any sort, prescriptions or any other health or bodily care item. I acknowledge that the City of Linden holds no insurance of any type, compensatory policy or death benefit on my behalf. I acknowledge that I have elected to perform voluntary service and cannot receive any benefit of any type. By signing below, I hereby certify that I have read, understand and fully consent to all conditions as herein stated.
I hereby certify that I have completely read this application and have made no false statements. I understand that if I make false statements on this application, I can be subject to penalties as prescribed by the law. By signing this application and all attachments, I certify that I understand what I have signed, and agree to all conditions stated or imposed therein. I agree that if I am not accepted for this position, that I will Hold Harmless the municipality and bring no further action. I further agree that if I do not comply within a timely manner as prescribed by the Director of Homeland Security with all requirements that this application is considered summarily withdrawn and no further review or consideration will be extended now or in the future.
I have read and understand the above certification, and I agree to its terms.