Application for Employment We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

Today’s date: _________________ Position applying for: _________________	682 Oxford Road, Oxford Nj 07863 (908) 223-7275 Fax (908) 223-7314
How did you hear about us? ___Newspaper (please include which one)_________________ ___Internet Search ___Friend/Relative (name)______________ ___Other_________________	District website: www.wcsssd.org

Personal Information:

Name: Social Security #:

Address: Telephone #:

Email address: Cellular #:

Check the appropriate response.	Yes	No
If you are under 18 years of age, can you provide proof of your eligibility to work?
Have you ever filed an application with us before? If yes, give date.
Have you ever been employed with us before? If yes, give date.
Do any of your friends or relatives work for us? If yes, list names:________________
Are you currently on a “lay-off” status or subject to recall?
Can you travel if the job requires it?
Are you currently employed?
May we contact your present employer?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigrant Status?
Have you ever been convicted of a violation(s) of law, excluding moving traffic violations? If yes, please list statute or ordinance.
Are you available to work: Full-time, part-time, or per diem
When will you be available to start work?
What is your desired salary range?

Education:	Name & Address of School	Course of Study	Years Completed	Degree Sought
High School/GED
Undergraduate College
Graduate/Professional
Other

If you are expected to complete an educational program in the near future, please indicate what type of program and the degree expected_________________________________________________________

____________________________________________________________________________________

Expected Date of Completion:__________________________________________________________

Work Experience: Please complete or attach resume. Start with your present or last job.

Employer
Address/Phone #
Dates Employed	Full-time or part-time
Title/Work Performed
Reason for leaving
Supervisor	May we contact your supervisor? Yes or No

Employer
Address/Phone #
Dates Employed	Full-time or part-time
Title/Work Performed
Reason for leaving
Supervisor	May we contact your supervisor? Yes or No

Employer
Address/Phone #
Dates Employed	Full-time or part-time
Title/Work Performed
Reason for leaving
Supervisor	May we contact your supervisor? Yes or No

Employer
Address/Phone #
Dates Employed	Full-time or part-time
Title/Work Performed
Reason for leaving
Supervisor	May we contact your supervisor? Yes or No

Employer
Address/Phone #
Dates Employed	Full-time or part-time
Title/Work Performed
Reason for leaving
Supervisor	May we contact your supervisor? Yes or No

Employer
Address/Phone #
Dates Employed	Full-time or part-time
Title/Work Performed
Reason for leaving
Supervisor	May we contact your supervisor? Yes or No

Comments: Include explanation for any gaps in employment. Also include any military experience or community/

volunteer organizations. Please list any accomplishments or memberships.

Personal Attributes: List at least 3 interpersonal skills that best describe you.

Other: Use this space for any other information you think would help us in evaluating your application, including training,

seminars and workshops, job-related skills, leadership activities, computer skills, public speaking,

professional/honor societies, performance awards, etc.

Professional References: Attached references are preferred. If not available, please list. Do not include family members.

Name	Address	Phone Number	Relationship	Best time to call
1
2
3
4

Please check off the following that apply to your current credentials:

___BA or BS

___MA/MS

___RN/LPN

___COTA/PTA

___Teaching Certificates

___NJ Substitute Certificate

___Home Health Aide Certificate

___Classroom experience as a teacher or aide in private or public schools

___Certified Teacher Assistant

___Extraneous experience with children with disabilities (including family member)

___Experience as licensed day care provider

___Experience as a Home Health Aide

___Current CPR/First Aide Certificates

___Defibrilllator training

___Workshop presenter

___Crisis Prevention Intervention Certification (CPI)

___Commercial Driver’s License (CDL)

___Formal training/experience with PECs.

___Office Experience

___Computer skills (experience with Word & Excel documents; email; etc.)

___Experience handling multiple phone lines

___Training in behavior management

___ABA/discrete trial training

___Experience with children in volunteer organizations (ie/ Sunday School Teacher, Scouts, etc.)

Others: Please list below

**Please attach any certificates, licenses, or degrees.

Applicant certification:

I certify that answers herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at employment decisions. In the event of employment, I understand that false or misleading information given in my application, resume, or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. _____________________________________ ________________________ Applicant’s Signature Date

We are an equal opportunity employer.

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