Fillable Passaic Valley Sewerage Commission 600 Wilson Avenue Newark, (The State of New Jersey)

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Passaic Valley Sewerage Commission 600 Wilson Avenue Newark, (The State of New Jersey)

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  • 112 other fields

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Page 1 of 6
The Passaic Valley Sewerage Commission is an Equal Opportunity Employer Rev 01/2018
Employment Application
Name: (last, first, middle initial)
Date:
Cell Phone Number:
Yes No
Yes No
Full Time Internship
Date available to start:
States?
Ha
ve you ever applied to or worked for PVSC before?
Yes No
Yes No If "yes", state their name & relationship:
Are you legally eligible for employment in the United
Career Fair:
Agency (name):
Newspaper:
Other:
(Please Print)
Applicant Information
Position type:
Are you a resident of New Jersey?
If Yes, Indicate Driver's License Number and State:
Salary or rate of pay expected:
Home Address:
(number & street, city, state and zip)
Email Address:
Do you have a valid driver's license?
Employee (
name ):
Where did you learn of this position?
(please check one and explain):
Yes No
Do you have any relatives working for PVSC?
New Jersey Residency Requirements: Effective September 1, 2011, the "New Jersey First Act" contains new residency requirements
for most public officers and employees. Current, new and prospective public employees should be aware that the New Jersey First Act,
N.J.S.A. 52:14-7, requires employees of all public employers, public agencies, authorities, boards, bodies, commissions, public
instututions of higher education, certain quasi-public entities, and all school boards to reside in the State of New Jersey unless otherwise
exempted by the law. If you do not live in New Jersey, you have one year after the date you start your job to relocate your residence to
New Jersey. If you do not do so, you may be removed from your office, position, or employment.
Is there any other information you would like us to consider regarding your employment availability?
If "yes", please explain (include dates):
Internet Website:
School/College:
Position applied for:(please specify)
Passaic Valley Sewerage Commission
600 Wilson Avenue
Newark, NJ 07105
(973) 344-1800
www.nj.gov/pvsc/
Page 2 of 6
The Passaic Valley Sewerage Commission is an Equal Opportunity Employer
Rev 01/2018
Graduate
(yes/no )*
High School
College
Graduate School
Business/Trade/
Vocational
*If you expect to graduate within the next nine months, give month and year you expect to obtain your degree.
Is there any other information you would like us to consider regarding your employment or availability?
List all prior employment on the following pages. Start with your current position and work
back. Account for periods of unemployment in separate blocks in order of occurrence.
List any other schools or training, including Armed Forces
(give names and location)
:
Applicants are required to fill out this application completely and include employment history.
(fluent only)
Degree
Major
Location
School Name
Type of School
Activities of Interest
(hobbies, civic, athletic or other )
:
List honors, awards and fellowships received:
May we contact your present employer regarding your character, qualifications and records of
NoYes
employment? If "no", please explain under "Reason for Leaving" for each employer listed below.
Employment Experience
Education
Page 3 of 6
The Passaic Valley Sewerage Commission is an Equal Opportunity Employer
Rev 01/2018
1
Dates of Employment: Exact Title of Position:
From: To:
Address: (number & street, city, state and zip)
Phone Number:
Position Type: (Full/Part Time, Temporary, or Contract)
Number of Employees Supervised: (if any)
Name of Immediate Supervisor:
Reason for Leaving:
Description of Duties, Responsibilities and Accomplishments:
2
Dates of Employment: Exact Title of Position:
From: To:
Place of Employment: (name) Address: (number & street, city, state and zip)
Phone Number:
Position Type:
(Full/Part Time, Temporary, or Contract)
Number of Employees Supervised:
(if any)
Name of Immediate Supervisor:
Reason for Leaving:
Description of Duties, Responsibilities and Accomplishments:
REMINDER: Start with your most recent employer.
Page 4 of 6
The Passaic Valley Sewerage Commission is an Equal Opportunity Employer
Rev 01/2018
Dates of Employment: Exact Title of Position:
From: To:
Place of Employment: (name) Address: (number & street, city, state and zip)
Phone Number:
Position Type: (Full/Part Time, Temporary, or Contract)
Number of Employees Supervised: (if any)
Name of Immediate Supervisor:
Reason for Leaving:
Description of Duties, Responsibilities and Accomplishments:
Dates of Employment: Exact Title of Position:
From: To:
Place of Employment: (name) Address: (number & street, city, state and zip)
Phone Number:
Position Type: (Full/Part Time, Temporary, or Contract)
Number of Employees Supervised: (if any)
Name of Immediate Supervisor:
Reason for Leaving:
Description of Duties, Responsibilities and Accomplishments:
3
4
Page 5 of 6
The Passaic Valley Sewerage Commission is an Equal Opportunity Employer
Rev 01/2018
Full Name: Occupation:
Present Home or Business Address: (number & street, city, state and zip)
Phone Number(s): Number of Years Known:
Full Name: Occupation:
Present Home or Business Address:
(number & street, city, state and zip)
Phone Number(s): Number of Years Known:
Third Reference
Full Name: Occupation:
Present Home or Business Address: (number & street, city, state and zip)
Phone Number(s): Number of Years Known:
References
position for which you are applying. Do not repeat the names of supervisors you listed previously
under the Employment Experience section.
First Reference
Second Reference
Licenses or certificates received: ( e.g. , Wastewater Operator License, Boiler Operator License, etc.)
Other employment: (use additional sheets of paper if necessary)
Please include level of license/certificate and state or licensing authority:
List three persons who are not related to you and who have knowledge of your qualifications for the
Please use this space to give additional information concerning your experience, education, computer
skills or qualifications:
Page 6 of 6
The Passaic Valley Sewerage Commission is an Equal Opportunity Employer
Rev 01/2020
Certification
Equal Opportunity Employer
The Passaic Valley Sewerage Commission (PVSC) is an equal opportunity employer. Federal and State
legislation prohibit discrimination because of age, race, creed, religion, national origin, ancestry, marital
status, civil union status, domestic partnership status, sex, gender identity or expression, genetic
information, atypical hereditary cellular or blood trait, nationality, affectional or sexual orientation, liability
for military service or disability, subject to conditions and limitations applicable alike to all persons.
I certify that all statements made in this application are true, complete and correct to the best of my
knowledge and belief, and are made in good faith. I am aware that if any of the foregoing statements
made by me are willfully false, I am subject to punishment. I also recognize that any intentional false
statements or omissions will be automatic grounds for dismissal. I understand that no representative of
the Passaic Valley Sewerage Commission (PVSC) has the authority to enter into any agreement for
employment for any specific period of time or to make any agreement contrary to the foregoing, and that
any such agreement to be enforceable, must be in writing and signed and approved by the PVSC
Executive Director or its Commissioners. Further, I authorize the PVSC to verify any and all information
contained herein, and to review my criminal and driving history, military, school and disciplinary records
from any source.
I hereby certify that all information in this application and all documents attached are true and valid.
___________________ _______________________________________________
Date Signature
Please complete Employment Application and submit to:
Passaic Valley Sewerage Commission
Attn: Human Resources Department
600 Wilson Avenue
Newark, NJ 07105
PVSCHumanResources@pvsc.com
Please attach any additional information you wish PVSC to consider.
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Passaic Valley Sewerage Commission 600 Wilson Avenue Newark, (The State of New Jersey)

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Completed 29 January 2021

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