Position Desired *
Employment Application
123 Main Ave
Your Town, NJ 90210
(220) 888-4000
Job Interest
  • Applicant Details
  • Education/Training
  • Employment History
  • Resume
  • References
  • Driver's/CDL License
  • EEO
  • Acknowledgement
Last Name *
Phone #1 *
Are any of your relatives employed by Your Town? *
City *
State *
Phone #2
Previous/Alternate Names
Are you a US Citizen, permanent resident or otherwise legally authorized to accept employment with Your Town? *
If Yes, list position(s):
Have you previously been employed by Your Town? *
Employment Eligibility
If Yes, list department and relationship:
Full Time
Address *
First Name *
Part Time
Any offer of employment by Your Town will be conditional upon your providing documentation required by law as evidence of personal identity and your authorization to work in the United States.
Are you over 18 years of age? *
Active Duty Start Date:
If yes, list Branch of Service:
Military Service
Active Duty End Date:
Have you served in the US Armed Forces? *
Date of Final Discharge:
Enter any previous education and training experience below. Click the "Add New Record" button, enter information and click "Save" for each.
A minimum of one previous education or training must be listed below. Please do not put "see resume". *
Will you need reasonable accommodations in order to perform the essential functions on the job? *
Describe the accommodations you will need (if any).
If yes, are there any you wish to exclude?
List any special skills, experience, training, licenses, certifications you have that are relevant to the position for which you are applying, or any additional information that we should consider.
May we contact these companies/institutions for references? *
List all employers starting with the most recent. Click the "Add New Record" button, enter information and click "Save" for each. *
Submit your resume by attaching it below. Attach resume in Word or PDF file format.
List at least three people we may contact in reference to your application. Do not include past or present supervisors listed under Employment section. Click the "Add New Record" button, enter information and click "Save" for each. *
Do you have a valid Driver's License?
Do you have a valid CDL License?
For positions requiring a Driver's License and/or CDL License
Driver's License State
List any equipment operated or other qualifications:
CDL Class
Driver License #
CDL License #
IMPORTANT—To ALL Applicants: To enable us to meet government reporting regulations, Your Town requests you complete this personal data form. Information will be used solely for government reporting purposes and will be detached and kept separate from your application. Any information you choose to provide will not be considered by Your Town for employment purposes and will be treated as confidential. Your voluntary cooperation is appreciated.
I qualify as a Special Disabled Veteran because I am:
If any of these definitions apply to you, please choose the appropriate choice. If you identify as more than one please choose "Two or More Races".
(A) was discharged or released with other than a dishonorable discharge;
(1) A veteran who is entitled to compensation (or who but for receipt of military retirement pay would be entitled to compensation) under laws administered by the Veterans Administration for disability;
Your Town is asking you to provide this information, because we must submit a statistical report in accordance with the regulations promulgated under 38 U.S.C. Section 2012 and must monitor statistics for the U.S. Government.
(A) which is rated 30% or more,
(1) A person who served more than 180 days of active military, naval or air service, any part of which was during the period August 5, 1964 through May 7, 1975 and who:
Veteran Status
Voluntary Information Only
(B) which is rated at 10 or 20%, but it has been determined, under Section 1506 of Title 38, U.S.C., that I have a “serious employment handicap;”
Race/Ethnic Category
(C) which is service connected and caused me to be released from active duty.
I qualify as a veteran of the Vietnam Era because I am:
  • Hispanic or Latino – a person of Cuban, Mexican, Puerto Rican, South or Central America, or other Spanish culture, regardless of race.
  • White (Not Hispanic or Latino) – a person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
  • Black or African American (Not Hispanic or Latino) – a person having origins in any of the black racial groups of Africa.
  • Asian (Not Hispanic or Latino) – a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
  • Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – a person having origins in any of the peoples of Hawaii, Guam, or the Pacific Islands.
  • American Indian or Alaska Native (Not Hispanic or Latino) – a person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community recognition.
  • Two or More Races (Not Hispanic or Latino) – all persons who identify with more than one of the above five races.
  • If you choose not to self - identify, please check box.
(B) was discharged or released from active duty because of a service connected disability.
Type Full Name :
Sign With Hand
Signature *
I hereby declare the information in the Application for Employment is true, correct and complete to the best of my knowledge. I understand that if employed, any misstatement or omission of fact on this application shall be considered cause for dismissal. I authorize the Your Town to check my background and obtain an investigative consumer report containing information obtained through personal interviews with my neighbors, friends and acquaintances. This report, if obtained, may include information as to my character, general reputation, personal characteristics and mode of living/ I have the right to make a written request within a reasonable period to receive information about the nature of any investigation.
Your Town is an AT-WILL, EQUAL OPPORTUNITY EMPLOYER and does not discriminate on the basis, of race, sex, color, religion, national origin, age, disability or veteran status in employment opportunities and benefits.