Employment Application

Please note – Upon successfully completing this application, you will be directed to a new page confirming your submission.  If you do not get redirected after clicking submit, please scroll through the whole form, looking for red annotations.  Many of the fields on this page are required, and leaving a required field blank will prevent a successful submission.  

Applicant Information:

Name:
Address:

Phone:

Email:

*Last 4 Digits of Social Security Number
XXX-XX-
*Position Applying For:

*Have you ever applied to the Authority before:
YesNo
If Yes, give Date:
*Date you can start

*Salary desired:

*Are you available to work:

Full TimePart TimeShift WorkTemporary

*Are you currently employed?

YesNo

If yes, may we contact you at work?

YesNo

*May we contact your current employer?

YesNo

*Are you currently on layoff status and subject to recall?

YesNo

*Do you possess a current driver’s license?

YesNo

*Do you possess a current commercial driver’s license?

YesNo

If so, are you registered with the Federal Motor Carrier Safety Administration (FMLSA) Drug and Alcohol Clearing House?

YesNo

If you are under eighteen years of age, can you provide proof of eligibility to work?

YesNo

*Are you legally eligible to work in the United States of America?

YesNo

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

The S. M. R. S. A. is an Equal Opportunity Employer M/F

*Employment History:

ALL fields in this section must be completed even if you attach a resume. List the greater of your last four employers or three years of work history and 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 1:
Address:
Job title:
Date started: I am still currently employedMy last date of employment was
Date left:
Work performed/Responsibilities:
Reason for leaving:
Supervisor's name and phone number:
May we contact for a reference? YesNo
Employer 2:
Address:
Job title:
Date started: Date left:
Work performed/Responsibilities:
Reason for leaving:
Supervisor's name and phone number:
May we contact for a reference? YesNo
Employer 3:
Address:
Job title:
Date started: Date left:
Work performed/Responsibilities:
Reason for leaving:
Supervisor's name and phone number:
May we contact for a reference? YesNo
Employer 4:
Address:
Job title:
Date started: Date left:
Work performed/Responsibilities:
Reason for leaving:
Supervisor's name and phone number:
May we contact for a reference? YesNo
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:

*Elementary School:

*Years Completed (Select One): 5678
*Graduated YesNo
Major Field N/A
*High School:

*Years Completed (Select One): 1234
*Graduated YesNo
Major Field
College:

Years Completed (Select One): 1234
Graduated YesNo
Major Field
Other:

Years Completed (Select One): 1234
Graduated YesNo
Major Field
Languages

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

Language 1:
Fluency: Speak SomeSpeak FluentlyReadWrite
Language 2:
Fluency: Speak SomeSpeak FluentlyReadWrite
Language 3:
Fluency: Speak SomeSpeak FluentlyReadWrite

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 that might prove beneficial in the selection process?

References

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

Reference 1:
*Name:
*Address:
*Phone Number:
*Years Known:
Reference 2:

*Name:
*Address:
*Phone Number:
*Years Known:
Reference 3:

*Name:
*Address:
*Phone Number:
*Years Known:
Understanding and Agreement:

As an applicant for a position with the SMRSA, 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 or accurate. If hired, I understand that I may be separated from employment if the Authority later discovers that information on this form was incomplete, untrue, or inaccurate. I give the SMRSA 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 Authority the right to secure additional job-related information about me. I release the South Monmouth Regional Sewerage Authority and its representatives from all liability for seeking such information. I understand that the South Monmouth Regional Sewerage Authority is an equal-opportunity employer and does not discriminate in its hiring practices. I understand that the Authority 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 Authority may terminate me at any time in accordance with its established policies and procedures. No representatives of the Authority may make any assurances to the contrary. I understand that any offer of employment may be subject to job-related medical, physical, drug, and/or psychological tests. I also understand that some positions may involve complete background, driver's license, and criminal checks.

*Applicant's Signature

*Date:

Conditions of Employment:
Please be advised that all offers of employment are conditional on the applicant passing a mandatory criminal background check and drug test. A pre-employment physical may also be required. Pursuant to the South Monmouth Regional Sewerage Authority personnel policy, all job applicants are required to sign a consent form for drug testing and if the test results are positive and are not accounted for by the legal use of prescription or non-prescription drugs the applicant shall be ineligible for hire unless they can establish a legal basis for the use of the drug or controlled substance for which they test positive. For your application to be considered, you must sign and date below.

*Applicant's Signature

*Date: