Nutley New Jersey

Thank you for your interest in the Township of Nutley.

The application below is for the Health Officer Position in the Department of Public Affairs and Health.

Fields marked with an * are required.

PERSONAL INFORMATION

*First Name

*Last Name

Address

*City

*State/Province

*Zip Code

*Phone

*Email Address

Desired Salary

If you are under 18, can you furnish a work permit?

Yes

Have you ever been employed here before?

Yes

Are you legally eligible for employment in this country?

Yes

Proof of U.S. citizenship or immigration status will be required upon employment

Date Available to Work

Type of Employment Desired

Full-Time

Part-Time

Temporary

Seasonal

Educational/Co-Op

Are you able to meet the attendance requirements of the position?

Yes

Have you ever been convicted of a felony in the last 7 years?

Yes

If Yes, please explain

Driver's License Number (if required for job) and State where issued.

RESUME

Upload resume as a .txt, .doc or .pdf file.

EMPLOYMENT HISTORY

EMPLOYER # 1

Employer Address

Employer Telephone

Dates Worked

Job Title

Immediate Supervisor and Title

Summarize the nature of worked performed and job responsibilities

Reason for Leaving

Hourly or Salary

Hourly

Salaried

Starting Hourly Rate or Salary

Final Hourly Rate or Salary

EMPLOYER # 2

Employer Address

Employer Telephone

Job Title

Immediate Supervisor and Title

Summarize the nature of worked performed and job responsibilities

Reason for Leaving

Hourly or Salary

Hourly

Salaried

Starting Hourly Rate or Salary

Final Hourly Rate or Salary

EMPLOYER # 3

Employer Address

Employer Telephone

Dates Worked

Job Title

Immediate Supervisor and Title

Summarize the nature of worked performed and job responsibilities

Reason for Leaving

Hourly or Salary

Hourly

Salaried

Starting Hourly Rate or Salary

Final Hourly Rate or Salary

QUALIFICATIONS

Any special skills and qualifications from employment or other experience that may qualify for work with the Township?

EDUCATIONAL BACKGROUND

HIGH SCHOOL

Years Completed

Did you graduate?

Yes

COLLEGE

Years Completed

Did you graduate?

Yes

Course of Study

OTHER

Years Completed

Did you graduate?

Yes

REFERENCES

REFERENCE # 1

Telephone

Years Known

REFERENCE # 2

Telephone

Years Known

REFERENCE # 3

Telephone

Years Known

RELEASE

It is understood and agreed upon any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the municipality if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the Township of Nutley reserves the right to terminate my employment at any time with or without cause and without prior notice. I understand that no representative of the Township has the authority to make any assurances to the contrary. I give the Township of Nutley the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Township of Nutley and its representatives for seeking such information and all other persons, corporation or organizations from furnishing such information.

Contact Info

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