Western Monmouth Utilities Authority
103 Pension Road, Manalapan, NJ 07726
(732) 446-9300
APPLICATION FOR EMPLOYMENT
(PRE-EMPLOYMENT QUESTIONNAIRE)
**AN EQUAL OPPORTUNITY EMPLOYER**
Date:
PERSONAL INFORMATION
Social Security Number:
Name
Address:
(Address Line 1)
(Address Line 2)
(City)
(State)
(Zip Code)
Phone:
Applicant's Email Address:
Employment Desired:
Position
Are you currently employed?
Yes
No
If so, may we inquire of your present employer?
Yes
No
Date you can start
Salary Desired
Have you ever applied to this company before?
Yes
No
Education
HIGH SCHOOL: Name and Location of School
Number of Years Attended
Did you graduate?
Yes
No
COLLEGE: Name and Location of School
Number of Years Attended
Did you graduate?
Yes
No
TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL: Name and Location of School
Subjects Studied
Number of Years Attended
Did you graduate?
Yes
No
General
Subjects of special study or research work
Special Skills
U.S. Military or Naval Service
Rank
Present Membership in National Guard or Reserves
* This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991
Former Employers (List below last three employers beginning with the most recent first)
1. Name and Address of Employer
(Address Line 1)
(Address Line 2)
(City)
(State)
(Zip Code)
Employment Dates: From/To
Position
Reason for leaving
Salary
2. Name and Address of Employer
(Address Line 1)
(Address Line 2)
(City)
(State)
(Zip Code)
Employment Dates: From/To
Position
Reason for leaving
Salary
3. Name and Address of Employer
(Address Line 1)
(Address Line 2)
(City)
(State)
(Zip Code)
Employment Dates: From/To
Position
Reason for leaving
Salary
References: Give the names of two persons not related to you, whom you have known at least one year.
Name
Business
Address:
(Address Line 1)
(Address Line 1)
(City)
(State)
(Zip Code)
Short Answer
Name
Business
Address:
(Address Line 1)
(Address Line 1)
(City)
(State)
(Zip Code)
Years Acquainted
Type your name in the box below
In case of emergency notify:
Phone
"I certify that all the information submitted by me on this application is true and complete, and I understand that if any fake information, omissions, or misrepresentations are discovered, m application my be rejected and, if I am employed, my employment may be terminated at any time.
In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."
Electronic Signature Disclosure and Consent Statement
You consent and agree that your use of a key pad, mouse or other device to select an item, button, icon, check box, to enter text, or to perform a similar act/action, while using the Western Monmouth Utilities Website secure forms, for the purpose of accessing or making any transactions regarding any agreement, acknowledgment, consent, terms, disclosures or conditions, constitutes your signature, acceptance and agreement as if actually signed by you in writing.
You further acknowledge and agree that the taking of any such actions by you evidence your intent to sign any such agreement, acknowledgment, consent, terms, disclosures or conditions.
You also agree that no certification authority or other third party verification is necessary to the validity of your electronic signature; and that the lack of such certification or third party verification will not in any way affect the enforceability of your signature or any resulting contract.
I, the applicant for/on this Employment Application, warrant the truthfulness of the information provided in this application. *
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree that I have typed my name and checked the box myself. *
Check box to submit your electronic signature
