* Name (Last, First, Middle):

Phone (Work):

Position applied for:

Have you ever applied to the (local unit type) before: Yes No

Date you can start:

Are you available to work: Full time   Part time   Shift work   Temporary

Are you currently employed: Yes No

May we contact you at work: Yes No

May we contact your current employer: Yes No

Are you currently on layoff status and subject to recall: Yes No

Do you possess a current driver’s license: Yes No

Do you possess a current commercial driver’s license: Yes No

Please list any endorsements:

If you are under eighteen years of age, can you provide proof of eligibility to work: Yes No

Are you legally eligible to work in the United States of America: Yes No

Pursuant to Federal Law, proof of US Citizenship or immigration status will be required if you are hired.

Note to Applicants: PLEASE NOTE YOU MUST READ AND UNDERSTAND THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING BEFORE ANSWERING THE QUESTION BELOW:

Can you perform the essential functions of the job for which you are applying either with or without a reasonable accommodation?
Yes No

Employment History: This section must be completed even if you attach a resume. List your last four employers, major assignments within the same employer. Begin with the most recent. Include any military service. Explain any gaps in employment in the space on this form marked comments located on the bottom of this page.

Employer:

Date started:

Date left:

Work performed/ responsibilities:

Address:

Job Title:

Starting Salary:

Reason for leaving:

Supervisor's name and phone number:

May we contact for a reference: Yes No

Employer:

Date started:

Date left:

Work performed/ responsibilities:

Address:

Job Title:

Starting Salary:

Reason for leaving:

Supervisor's name and phone number:

May we contact for a reference: Yes No

Employer:

Date started:

Date left:

Work performed/ responsibilities:

Address:

Job Title:

Reason for leaving:

Supervisor's name and phone number:

May we contact for a reference: Yes No

Employer:

Date started:

Date left:

Work performed/ responsibilities:

Address:

Job Title:

Reason for leaving:

Supervisor's name and phone number:

May we contact for a reference: Yes No

Comments:

Education: Provide information on your formal schooling and education. Include elementary, secondary, and post-secondary education, if any. Include any formal vocational or professional education. For high school and post-secondary education, indicate any major or specialty, such as Academic, Business, or Trade.

School:	Years completed: (Circle)	Graduated: (Circle)	Major Field:
High:	1 2 3 4	Yes No
College:	1 2 3 4	Yes No
Other:	1 2 3 4	Yes No

Languages: List any foreign languages you know and indicate your level of proficiency.

Language:	Speak Some:	Speak Fluently:	Read:	Write:

Special Skills & Experience: State any special skills, experience, training, licenses, certifications or other factors that make you especially qualified for the position for which you are applying.

Comments & Additional Information: Is there any additional information about you we should consider?

References: Provide the names, addresses and phone numbers of three people whom we may contact as a reference. They should not be relatives or former supervisors

Name & Address:	Phone Number:	Years Known:

As an applicant for a position with the Borough of Wildwood Crest, I understand and agree that I must provide truthful and accurate information in this application. I understand that my application may be rejected if any information is not complete, true and accurate. If hired, I understand that I may be separated from employment if the Borough later discovers that information on this form was incomplete, untrue, or inaccurate. I give the Borough the right to investigate the information I have provided, talk with former employers (except where I have indicated they may not be contacted). I give the Borough the right to secure additional job-related information about me. I release the Borough and its representatives from all liability for seeking such information. I understand that the Borough is an equal-opportunity employer and does not discriminate in its hiring practices. I understand that the Borough will make reasonable accommodations as required by the Americans with Disabilities Act. I understand that, if employed, I may resign at any time and that the Borough may terminate me at any time in accordance with its established policies and procedures. No representatives of the Borough may make any assurances to the contrary. I understand that any offer of employment may be subject to job-related medical, physical, drug, or psychological tests. I also understand that some positions may involve complete background and criminal checks. For your application to be considered, you must sign and date below.

Applicant's Signature:

How did you learn about this position? Advertisement   Employment Agency
Friend   Relative   Walk-in   Other (Explain)

Gender: Male Female

White
African-American (non-Hispanic)
Hispanic
American Indian/Alaskan native
Asian/Pacific Islander
Other

Individual with a disability
Vietnam-era veteran (served between 1964 and 1975)
Disabled veteran