Applicants are considered for all positions regardless of race, color, religion, sex, national origin, marital status, sexual orientation, veteran status or the presence of an on-job-related medical condition or handicap.

As an applicant, I will verify my employment eligibility by presenting proof of citizenship or immigration status prior to employment. If I am under the age of 18, I will also provide any necessary work permits(s) prior to starting work.

    Please the position for which you are applying:

    Full Name:

    Address:

    City, State Zip:

    >Phone Numbers (Home and Cell):

    Email Address:

    Driver's License/State ID Number and State:

    If you are under 18, indicate your Date of Birth:

    The Age Discrimination Employment Act forbids discrimination on the basis of age to individuals aged 40 and over.

     

    Education






    Please indicate all degrees, special training, skills, equipment operated, specialized work, experience or other factors we should consider:

    Do you speak or write any languages other than English? If so, please indicate the language and your capability below:

     

    PERSONAL REFERENCES

    Please provide three personal references (other than relatives):

    Reference #1 (Name, Address, and Phone):

    Reference #2 (Name, Address, and Phone):

    Reference #3 (Name, Address, and Phone):

     

    Employment History

    (Please start with your most recent position or present employer)






     






     





    Desired Salary/Hourly Rate:

     

    Other Information

    Are you currently employed?

    May we contact your current/prior employers?

    Please list any of your current/prior employers you do NOT wish us to contact:

    Do you have a resume or reference letter?

    You may upload your resume here:

    You may upload your reference letter here:

    Have you been employed by Worth Township previously?

    Are you working in a capacity that may be interpreted as a conflict of interest?

    Please explain any perceived conflict of interest:

    Are you currently on a lay off?

    If on a layoff, what is your job recall status:

    Have you ever been convicted of any crime under state or federal law?

    If convicted of a crime, please explain in detail:

    Have you ever served in the military?

    Were you honorably discharged?

    If you were not honorably discharged, please explain:

    Are you presently in the National Guard or Armed Forces Reserves?

    Can you travel if the job requires it?

    Can you work overtime, if required?

    Do you have a current driver's license in good standing?

    Do you have a commercial driver's license (CDL) in good standing?

    The Township may requisition a copy of your driving record at our expense. Do you have any objection to this requirement?

    Would you take a pre-employment physical at our expense?

    Would you take a pre-employment drug/alcohol test at our expense?

    Are you (or your spouse) related to a present or former Worth Township employee or official?

    If you are related to an employee or official, whom?

    Worth Township has certain policies that all employees must follow, will you adhere to them?

    Are you applying for full-time or part-time work?

    Are you applying for seasonal/summer work?

    When are you available for an interview?

    If offered employment, when can you report to work?

    Is there any additional information you feel may be helpful to us in considering your application?

     

    Applicant's Statement

    I understand that my employment may be contingent upon satisfactory results from any test or investigation and upon my ability to work efficiently during the probationary period.

    I certify that the information given herein is true and complete to the best of my knowledge and I voluntarily authorize the Town of Worth to verify all information related to my education, prior employment, and personal references. I also release from liability all persons and entities supplying or collecting such information.

    In the event of my employment, I understand that any misrepresentation or deliberate omission of any fact in my application, resume, and any other materials or during an interview will be justification for refusal of employment or if already employed will result in termination.

    I understand that I am required to abide by any and all rules, regulations, and policies of the Town of Worth.

    I understand that all information provided in this application will be treated confidentially and will only be used to help assure the best use of my capabilities as an applicant. If employed, this application will be placed in my personnel file or, if not immediately employed, this application shall be considered active for a period of time not to exceed six months. After that time, I may re-apply.

    I understand that acceptance of an offer of employment with the Town of Worth does not create a contractual obligation upon the Township to employ me in the future.

    Signature:

    Date: