Borough of Rockaway
Employment Application
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1
of
7
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Today's Date
Applicant Information
Last Name
First Name
Middle Initial
Street Address
Apt/Unit#
City
State
Zip Code
Phone
Email
Position Applied for
Type of Employment
Full Time
Part Time
Temporary
Date Available
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1926
1925
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1920
Desired Salary
Are you currently employed?
Yes
No
Current Employer
Do you possess a valid driver's license?
Yes
No
Do you possess a valid commercial driver's license?
Yes
No
Have you ever worked for the Borough of Rockaway?
Yes
No
If yes, when?
EDUCATION
High School
Name of High School
Address
Did you graduate?
Yes
No
Diploma
College
Name of College
Address
Did you graduate?
Yes
No
Degree
Would you like to list another college?
Yes, I’d like to add another college
No, no other colleges
I’d like to add a trade / specialized school
I’d like to provide additional education information
College 2
Name of College
Address
Did you graduate?
Yes
No
Degree
Other Education / Trade / Specialized School
Name of trade or specialized school
Address
Did you graduate/receive certification?
Yes
No
Degree/Certification obtained
Additional Education Information
If you have any additional education information, you may provide it here.
REFERENCES
Please list three professional references.
Reference 1
Full Name
Relationship
Phone
Years Known
Add another reference?
Yes, I have another reference
No, I don’t have another reference
Reference 2
Full Name
Relationship
Phone
Years Known
Add a third reference?
Yes, I have another reference
No, I only have two references
Reference 3
Full Name
Relationship
Phone
Years Known
PREVIOUS EMPLOYMENT
Employment 1
Company
Phone
Address
Supervisor
Job Title
Job Responsibilities
Employment From
Employment To
May we contact your supervisor for a reference?
Yes
No
Reason for Leaving
Add another previous employer?
Yes. I have another previous employer
No, I don’t have another previous employer
Employment 2
Company
Phone
Address
Supervisor
Job Title
Job Responsibilities
Employment from
Employment to
May we contact your supervisor for a reference?
Yes
No
Reason for Leaving
Add a third previous employer?
Yes, add a third previous employer
No, I only have two previous employers
Employment 3
Company
Phone
Address
Supervisor
Job Title
Job Responsibilities
Employment from
Employment to
May we contact your supervisor for a reference?
Yes
No
Reason for Leaving
Additional Employment Information
If you have any additional employment information, you may provide it here.
MILITARY SERVICE
Branch
From
To
Rank at Discharge
Type of Discharge
If other than honorable, explain:
No military service
No, I did not serve in the military
ADDITIONAL INFORMATION, RESUME, DISCLAIMER, and SIGNATURE
Additional Information
Please use this area to provide any additional information that you may feel is important for us to know when considering your employment.
Resume
You may upload your resume here so that it is included with your application.
Accepted file types: pdf, doc, docx, Max. file size: 1 MB.
DISCLAIMER and SIGNATURE
As an applicant for a position with the Borough of Rockaway, 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 of Rockaway later discovers that information on this form was incomplete, untrue, or inaccurate. I give the Borough of Rockaway 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 of Rockaway the right to secure additional job-related information about me. I release the Borough of Rockaway and its representatives from all liability for seeking such information. I understand that Borough of Rockaway is an equal-opportunity employer and does not discriminate in its hiring practices. I understand that the Borough of Rockaway 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 of Rockaway may terminate me at any time in accordance with its established policies and procedures. No representatives of the Borough of Rockaway 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. Incompliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire. I have read and understand the above statements in its entirety.
Disclaimer
(Required)
If this application leads to employment, I understand that false or misleading information in my application or
interview may result in my release
I certify that my answers are true and complete to the best of my knowledge.
Signature
Date
Name
This field is for validation purposes and should be left unchanged.