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Employment is conditional upon the results of the criminal background check. An answer of “Yes” may disqualify you from employment depending upon the circumstances involved. If “Yes”, please explain below.

This section must be completed even if you attach a resume. List your last four employers, major assignments within the same employer. Begin with the most recent. Include any military service. Explain any gaps in employment in the space on this form marked comments located on the bottom of this page.

Provide information on your formal schooling and education. Include elementary, secondary, and post-secondary education, if any. Include any formal vocational or professional education. For high school and post-secondary education, indicate any major or specialty, such as Academic, Business, or Trade.

List any foreign languages you know and indicate your level of proficiency.

As an applicant for a position with the (local unit name), 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 Township of Rockaway later discovers that information on this form was incomplete, untrue, or inaccurate. I give the (local unit name) 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 Township of Rockaway the right to secure additional job-related information about me. I release the (local unit name) and its representatives from all liability for seeking such information. I understand that the (local unit name) is an equal-opportunity employer and does not discriminate in its hiring practices. I understand that the Township 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 Township of Rockaway may terminate me at any time in accordance with its established policies and procedures. No representatives of the Township 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.

Please be advised that all offers of employment are conditional on the applicant passing a mandatory criminal background check and drug test. A pre-employment physical may also be required. Pursuant to our personnel policy, all job applicants are required to sign a consent form for drug testing and if the test results are positive and are not accounted for by the legal use of prescription or non-prescription drugs the applicant shall be ineligible for hire unless they can establish a legal basis for the use of the drug or controlled substance for which they test positive. For your application to be considered, you must sign and date below.