Form

158 MILLBROOK ROAD

BLAIRSTOWN, NEW JERSEY 07825

http://www.princeton.edu/princetonblairstown

Phone: (908) 362-6765

Fax: (908) 362-7699

Thank you for applying for employment with the Princeton-Blairstown Center. A complete application must also include two e-mails of reference (see below).

Today's date:

/ Month / Day Year

Full Name

First Name Last Name

Present Address:

City:

State/Province:

Zip/Postal Code:

E-Mail Address:

Home Phone Number

- Area Code Phone Number

Cell Phone Number

- Area Code Phone Number

Will you be 19 by date of hire?

Yes No

Are you legally allowed to work in the USA?

Yes No

Position Applied for:

How did you hear about us?

Type of School:

Name of School:

Number of Years Completed:

Graduation Date:

/ Month / Day Year

Major or Degree:

Use this additional section in case you have more than one Major or Degree

Type of School:

Name of School:

Number of Years Completed:

Graduation Date:

/ Month / Day Year

Major or Degree:

Have you ever been convicted of a misdemeanor, felony or federal ofense:*

Yes No

*If yes, please explain:

Do you have a driver's license:

Yes No

State of issue:

Please list the last three employers in order, most recent first. Please note: We will contact two of the people on this list. Each section must either be filled in or an explanation provided.

1.

Name of Most Recent Employer:

Name of Last Supervisor:

Dates of Employment:

From:

/ Month / Day Year

To:

/ Month / Day Year

Complete Address:

Phone Number

- Area Code Phone Number

E-mail

Last Job Title:

Reason for Leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:

May we contact this employer:

Yes No

2.

Name of Employer:

Name of Last Supervisor:

dates of Employment:

From:

/ Month / Day Year

To:

/ Month / Day Year

Complete Address:

Phone Number

- Area Code Phone Number

E-mail

Last Job Title:

Reason for Leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:

May we contact your Employer:

Yes No

3.

Name of Employer:

Name of Last Supervisor:

Dates of Employment:

From:

/ Month / Day Year

To:

/ Month / Day Year

Complete Address:

Phone Number

- Area Code Phone Number

E-mail

List Job Title:

Reason for Leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:

May we contact your Employer:

Yes No

Do you have any experience working in a Camp kitchen or any other commercial kitchen setting?

Yes No

If you answered yes, please elaborate on your experience here:

Do you have any cleaning experience from a prior job?

Yes No

If you answered yes, please elaborate on your cleaning experience:

Are you able to work flexible days and hours?

Yes No

If you answered no to the above question, please indicate any consistent hours or days you are unable to work (i.e, if you can only work early mornngs and not evenings or only work weekdays and not weekends). If you have no restrictions, please indicate that here.:

Please list two people who are not related to you and who are not named in the "employment" section above, who can comment on your education, work and life experiences. Please ask your references to submit the form online by going to the secton titled "references" at the bottom of the page on our website at: www.princeton.edu/princetonblairstown/employment

Name of Reference 1

Relationship

Address

E-mail

Phone Number

- Area Code Phone Number

Name of Reference 2

Relationship

Address

E-mail

Phone Number

- Area Code Phone Number

SMOKING : Staff are not permitted to smoke while on duty or at any time while on Center property. One warning will be given for infractions. Repeated infractions will result in disciplinary action.

DRUGS : The possession or use of any illegal drugs on Center property or at any time while employed by Princeton-Blairstown Center will be grounds for immediate termination of employment.

ALCOHOL : Possession and/or use of alcoholic beverages while on duty in leadership or support capacity is prohibited. Staff members are expected to return to the Center after time off in a "ready to work" condition. "Ready to work" is defined as neither being under the influence of alcohol nor experiencing the effects of alcohol consumption. The Co-Directors and/or their designee reserve the right to determine "ready to work" status.

The Princeton-Blairstown Center maintains an alcohol free environment during the summer season. Alcohol free means that staff may not consume, supply, encourage or condone the use of alcohol during the summer season on Center property. Violation of this policy WILL lead to disciplinary action up to and including termination.

Can you commit to the Smoking/Drugs and Alcohol Policy?

Yes No

Please list and describe all relevant certifications and licenses.

First-Aid Type

Expiration Date:

/ Month / Day Year

CPR - Type

Expiration Date:

/ Month / Day Year

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

I authorize you to make such investigations and inquiries into my past employment, educational credentials, or other employee-related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools or any other persons from all liability in responding to inquiries in connection with this application.

In the event of being an employee of Princeton-Blairstown Center, I understand that false or misleading information given in this application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Princeton-Blairstown Center as permitted by law

Full Name

First Name Last Name

Today's Date:

/ Month / Day Year

If you would like a copy of your application, please print it out before clicking the "submit" buttom below.

PRINCETON-BLAIRSTOWN CENTER

EMPLOYMENT APPLICATION

PRESENT ADDRESS

EDUCATION

EMPLOYMENT INFORMATION

Experience

REFERENCES

Princeton-Blairstown Center's Policy on Smoking, Drugs and Alcohol

Certifications

To be read and signed by the applicant