Division of Human Resources

Department of Administrative Service

Employment Application

Step 1: Begin the Application

Be sure to read the directions on EACH section and complete the entire process.

IMPORTANT: DO NOT USE YOUR BROWSERS BACK BUTTON WHILE COMPLETING THE APPLICATION. If you make a mistake you will have the opportunity to review and make corrections at the end of the process. You will also be able to print a copy of your application for your records.

IMPORTANT: Fields marked with * are required. You will not be able to proceed without entering your First and Last Name, Address, Phone Number, Email Address and Social Security Number. If you do not wish to enter this information please print the application from the link to the left and mail the completed application.

Position Desired:

Other positions you feel qualified for:

Personal Data

Last Name: *

First Name: *

MI: *

County Of Residence:

Street Address:*

City: *

State:

Zip

Telephone (with area code):
Format: ###-###-#### *

Message Phone (with area code):
Format: ###-###-#### *

Email Address:

Confirm Email Address:

Are you either a United States citizen or permanent resident? Yes No

Are you 18 years of age or over? Yes No

Are you related to any County employee? Yes No

If YES, please provide name and relationship:

Relative First Name:

Last Name:

Relationship:

Have you ever held a position with Atlantic County Government? Yes No

Start date:

End Date:

Previous Employment History

List most recent employer first. Please list 10 years of employment history, and be sure to include Name of Employer, full address, phone number, and dates you were employed. These must be filled in completely in order to move on to the next section. Only if you do not have enough employment history may you fill in N/A to move on. N/A is not appropriate to use simply because you are attaching a resume with that information, it must be filled in on the application.

May we make a reference check with your present Employer(s)? Yes No

Employer(1):*

Telephone: (include area code):*

Street Address:*

City:*

State:*

Zip:*

Dates Employed:

Start Date:*

End Date:*

Supervisor:

Position Held:

Duties:

Number of Hours Per Week:

Reason for leaving:

Employer(2):*

Telephone: (include area code):*

Street Address:*

City:*

State:*

Zip:*

Dates Employed:

Start Date:*

End Date:*

Supervisor:

Position Held:

Duties:

Number of Hours Per Week:

Reason for leaving:

Employer(3):*

Telephone: (include area code):*

Street Address:*

City:*

State:*

Zip:*

Dates Employed:

Start Date:*

End Date:*

Supervisor:

Position Held:

Duties:

Number of Hours Per Week:

Reason for leaving:

Have you ever been dismissed from any of these positions? Yes

Need Additional Employment Spaces? Yes You will be able to enter additional employers AFTER completing this page and clicking the "Submit Application" button.

Office Skills

Typing speed:

Computer, Hardware/Software packages:

Education

High School

Location:

Highest Grade

Degree/Course of Study

College

Location:

Highest Grade

Degree/Course of Study

Graduate

Location:

Highest Grade

Degree/Course of Study

Other Special Training

Location:

Highest Grade

Degree/Course of Study

State any additional...

United States Military Service

Veteran? Yes

Service Branch:

Special Service Training:

If a tentative offer of employment is made, are you willing to:

a) receive a complete pre-hire health screening? Yes

b) authorize a release of the results to the Division of Human Resources? Yes

References

Reference

First Name:

Last Name:

Address (line 1):

Address (line 2):

City:

State:

Zip:

Telephone Number:

Reference

First Name:

Last Name:

Address (line 1):

Address (line 2):

City:

State:

Zip:

Telephone Number:

Reference

First Name:

Last Name:

Address (line 1):

Address (line 2):

City:

State:

Zip:

Telephone Number:

In case of emergency contact:

Last Name:

First Name:

Address (line 1):

Address (line 2):

City:

State:

Zip

Telephone Number:

Relationship:

EEO Information

The Federal Equal Employment Opportunity Commission requires us to monitor employment and referral. The data requested on this form will only be used for information and reporting purposes. In no case will it affect a hiring decision or tenure of employment. Submission of information is voluntary.

Position(s) Applied for:
Referral Source:		Advertisement Friend Relative Walk In County Web Page Other, specify:
DOB:
Sex: Male Female Undesignated or Non-Binary
Race/Ethnicity:		White (not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. American Indian or Alaska Native (not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. Asian (not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Two or More Races (not Hispanic or Latino) - All persons who identify with more than one of the above five races.

Driver's License Information:

If the operation of a vehicle is necessary for this position, a valid N.J. driver's license is required.

Do you have a valid N.J. license? Yes No

If position requires a Commercial Driver's License (CDL):

Please list driver's CDL license number:

List the level of CDL endorsement(s) held:

We are an Equal Employment Opportunity Employer. All applications are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, physical or mental disabilities, or other status as protected by Federal or State Law.

APPLICANT'S STATEMENT

I certify that the answers given herein are true and complete to the best of my knowledge.I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and does not intend to be a contract of employment.

I understand that if my application is incomplete it may be rejected.

I understand that submission of false information on this application or in an employment interview is grounds for withdrawal of job offer or termination of employment. I understand, also, that I am required to abide by all rules and regulations of Atlantic County Government.

I Agree with the above statements.

Date of Application: 4/16/2024

AN EQUAL OPPORTUNITY EMPLOYER

In accordance with NJSA 34 ("Right to Know" Law), information is available on hazardous substances you may be potentially exposed to at various work sites. For more information, contact the Atlantic County Division of Public Health.

Atlantic County, NJ

Serving the Needs of County Residents, Businesses and Visitors

Division of Human Resources

Department of Administrative Service

County Employment

Employment Application

Personal Data

Previous Employment History

May we make a reference check with your present Employer(s)? Yes No

Office Skills

Education

United States Military Service

References

In case of emergency contact:

EEO Information

Driver's License Information:

APPLICANT'S STATEMENT

AN EQUAL OPPORTUNITY EMPLOYER

Atlantic County, NJ

Serving the Needs of County Residents, Businesses and Visitors

More Resources

ACEANJ.COM

Employment Application

Personal Data

Previous Employment History

May we make a reference check with your present Employer(s)? Yes No

Office Skills

Education

United States Military Service

References

In case of emergency contact:

EEO Information

Driver's License Information:

APPLICANT'S STATEMENT

AN EQUAL OPPORTUNITY EMPLOYER