City of Orange Township EMPLOYMENT APPLICATION INSTRUCTIONS: Return the completed application with all requested information to: APRIL 14, 2016

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1 Mayor s Office of Employment Training (MOET) Program City of Orange Township EMPLOYMENT APPLICATION The Mayor s Office of Employment Training (MOET) teaches employment skills while providing valuable, hands on work experience. MOET develops career awareness, money management and social skills for the work place. MOET is open to all City of Orange Township residents ages (14-21). The employment period to commence June 27, 2016 and ends August 5, INSTRUCTIONS: Each applicant may submit only one application. The application must be completed in its entirety. Return the completed application with all requested information to: The City of Orange Township Office of Personnel 29 North Day Street Orange, NJ Completed applications will only be received Tuesdays and Thursdays, between the hours 3-4:30pm. Application Deadline APRIL 14, 2016 All applications will be reviewed. If you are selected for an interview by the MOET panel you will be notified via mail. All applicants will be contacted via postal mail indicating program acceptance or denial. If accepted you will be notified of Orientation and job assignment via mail. Applications will be rejected if you fail to submit the required documentation. Visit us on the web at For inquiries and/or concerns, contact Dr. Robert Austin at (973)

2 Mayor s Office of Employment Training (MOET) Program City of Orange Township EMPLOYMENT APPLICATION POSITION APPLIED FOR: Instructions: Please type or print answers to all questions. Social Security Number: - - Last Name: First Name: M.I.: Suffix: (Jr./Sr.) Address (Number and Street): City and State: Zip Code: Applicant s Home Phone#: - - Applicant s Cell Phone#: - - Days/Hours available to Work: No Pref Thur Mon Fri Tue Sat Wed Sun Desired Hourly Rate of Pay: $ Driver s License: yes no How many hours can you work per week? If you are 17 years old or younger, enter your age: Ethnicity (Check One): American Indian Asian (Non- Hispanic) Hispanic/Latino White Black (Non- Hispanic) White Other Other than English, what language(s) are you most comfortable speaking? Spanish Haitian/Creole Chinese If other, please name Applicant s Address: Name of Parent/Guardian: Emergency Contact Name: Emergency Contact Phone#: 2

3 JOB CATEGORY OF INTEREST (please select one): Administration Health Care Retail Government Child Care Technology Finance Sports & Fitness Customer Service Business Camps/Recreation Senior Citizen Homes Funeral Homes EDUCATION (check one): Student in HS College Student HS Graduate GED recipient Left HS before graduating Please circle your current grade: High School School Name Address Dates Attended (From- To) Credit Hours Completed Type of Degree Major Did You Graduate? Technical or Business School College or University Please list any additional skills, knowledge, and abilities you possess: What is the applicant s long- term career goal? Do you have any prior work experience? Yes No The applicant has secured his/her working papers. Yes No The applicant certifies that they are eligible to work in the United States. Yes No Have you ever been convicted of a crime? Yes No If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type of rehabilitation. 3

4 WORK HISTORY Instructions: Begin with your present or most recent employer/volunteer experience and work background, list all positions held separately; even if it is the same employer. Clearly describe the work (duties) you performed. If you do not have volunteer/work experience, please write N/A or Not Applicable. a. Official Job Title: Company Name: Company Address: Company Phone#: ( ) - Title and name of immediate supervisor: Employment Dates Salary/Wage: $ Per Hour: $ Reason for Leaving: What were your Duties (please list)? b. Official Job Title: Company Name: Company Address: Company Phone#: ( ) - Title and name of immediate supervisor: Employment Dates Salary/Wage: $ Per Hour: $ Reason for Leaving: What were your Duties (please list)? Please attach resume if necessary. CERTIFICATION: I certify that the statements made by me on this application are true and complete to the best of my knowledge and are made in good faith. I understand that if I knowingly make any misstatement of fact, I am subject to disqualification and dismissal and to such other penalties as may be prescribed by law or personnel regulations. All statements made on this application, including employment information, are subject to verification as a condition of employment. APPLICANT PRINT NAME: APPLICANT SIGNATURE: PARENT/GUARDIAN PRINT NAME: PARENT/GUARDIAN SIGNATURE: MOET IN- TAKE OFFICER PRINT NAME: MOET IN- TAKE OFFICER SIGNATURE: 4

5 If selected, to accept the job, you must show a picture I.D., Social Security Card and your current report card (if you are in school). In order to be placed in a summer job, you will need to bring certain documents to the MOET office. You must submit COPIES of one (1) item from categories 1-8 listed below. These items are needed to officially complete your enrollment so that you are eligible for a MOET job. Not that some documents may satisfy more than one category (i.e. U.S. Birth Certificate or current U.S. Passport for Categories 3 and 6). REMINDER: ONLY COPIES OF THESE DOCUMENTS WILL BE ACCEPTED PROOF OF IDENTITY Official Picture ID (school, city, state, government issued) PROOF OF EMPLOYMENT AUTHORIZATION Report Card (dated within the last 6 months) OR Official School Transcript OR NJ Driver/Non- Driver s License OR Voter s Registration Card OR U.S. Military Card/ Draft Record PROOF OF AGE Birth Certificate OR Benefit Card OR NJ Driver/Non- Driver s License OR Alien Registration Card OR Valid U.S. Passport PROOF OF SOCIAL SECURITY NUMBER Social Security Card (ONLY) WORKING PAPERS (Must be age applicable) If you are under the age of 18 at the time of application, you must submit your most current working papers. Working papers can be acquired through your school. If you are not attending school, call 311 or contact your local District Office. 14 and 15 years of age: Blue Card 16 and 17 years of age: Green Card WORKING PAPERS (Must be age applicable) If you are under the age of 18 at the time of application, you must submit your most current working papers. Working papers can be acquired through your school. If you are not attending school, call 311 or contact your local District Office. 14 and 15 years of age: Blue Card 16 and 17 years of age: Green Card MOET APPLICATION A signed MOET application is required for all youth. Youth under the age of 18 are required to have the signature of a parent or guardian. PLEASE BE SURE TO INCLUDE RECOMMENDATION (see top of pg. 7) PROOF OF PHYSICIAN S CERIFICATION You must have a physical or obtain a doctor s note. A school physical (including a sports physical) performed during freshman year is good for all four years of high school (unless the school district policy specifies more frequent physicals). School Physical Doctor s Note Please note: All references to the word current means documents dated within the last six (6) months or where applicable, documents which are still valid and have not expired. 5

6 RECOMMENDATION: Please provide a written recommendation from a teacher or school representative. This is only required for high school students. PERSONAL REFERENCES: List Non- Relatives whom you have known for at least one year Name and Address Telephone No. Relationship Years Known Authorization to Verify Information: I authorize the City of Orange Township to obtain information about me from my previous employers, schools and credit sources. I authorize my previous employers AND/OR school(s) that I have attended and all credit sources to disclose to the City of Orange Township such information about me as may be requested. ( ) Initials Accuracy of Application Responses: I verify that the statements I have made in this application are true and complete. I understand that if I am hired, any false or incomplete statements in this application will be grounds for immediate termination. ( ) Initials Authorization to Perform a Background Check: I hereby authorize the City of Orange Township to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that the City of Orange Township may utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by entities of the City s choice. I also understand that I may withhold my permission and that in such a case, an investigation will be done, and my application for employment will not be processed further. I authorize the background check ( ) initials OR I do NOT authorize the background check ( ) initials PRINT NAME SIGNATURE DATE If under the age of 18, your parents are required to sign below: PARENT(S) NAME PARENT SIGNATURE DATE 6