PATERSON PUBLIC SCHOOLS
HUMAN RESOURCES DEPARTMENT
90 DELAWARE AVENUE
PATERSON, NEW JERSEY 07503
CAFETERIA MONITOR APPLICATION
DATE OF APPLICATIONNAME / SOCIAL SECURITY NO.
ADDRESS
CITY/STATE/ZIP
TELEPHONE NO#
I REQUESTED THE FOLLOWING SCHOOLS / CHECK IF NO PREFERENCE
HAVE YOU WORKED FOR THE PATERSON PUBLIC SCHOOL DISTRICT IN THE PAST? / YES / NO
IF YES: DATES WORKED / POSITION
EDUCATION / NAME OF SCHOOL AND LOCATION /
DATE OF GRADUATION
ELEMENTARY SCHOOLHIGH SCHOOL
OTHER
* PLEASE NOTE- TO BE ELIGIBLE TO BECOME A CAFETERIA MONITOR, YOU WILL NEED TO HAVE A HIGH SCHOOL DIPLOMA.
WHAT FOREIGN LANGUAGE (S) DO YOU SPEAK FLUENTLY?REFERENCES: GIVE THE NAME OF TWO PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN
FOR AT LEAST THREE YEARS:
NAME ADDRESS TELEPHONE NO. YEARS KNOWN
PERSONAL DATA: DO YOU HAVE ANY PHYSICAL OR MENTAL DISABILITY, ACCIDENT OR ILLNESS WHICH WOULD PREVENT
SATISFACTORY JOB PERFORMANCE? / YES / NOIF YES, PLEASE EXPLAIN
HAVE YOU EVER BEEN CONVICTED OF ANY CRIME OR VIOLATION OF THE LAW OTHER THAN TRAFFIC VIOLATIONS?
YES / NOIF YES, PLEASE EXPLAIN
IS THERE ANY CRIMINAL ACTION PENDING AGAINST YOU?
/YES
/ /NO
/ARE YOU A RELATIVE* OF AN EMPLOYEE OR BOARD OF EDUCATION MEMBER OF THE PATERSON PUBLIC SCHOOLS?
YES / NOIF YES, RELATIVE'S NAME
/RELATIONSHIP:
/I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND AND AGREE THAT REPRESENTATION OR
OMISSION OF FACTS REQUESTED IS CAUSE FOR DISMISSAL AND THAT MY EMPLOYMENT IS FOR NO DEFINITE PERIOD OF TIME AND MAY
REGARDLESS OF THE PAYMENT OF MY WAGES AND SALARY BE TERMINATED AT ANY TIME WITHOUT PREVIOUS NOTICE.
*Relative is an individual’s spouse or the individual’s parent, child, brother, sister, aunt, uncle, niece, nephew, grandparent, grandchild, son-in-law, daughter-in-law, stepparent,
Stepchild, stepbrother, stepsister, half brother or half sister whether the relative is related to the individual or the individual’s spouse by blood, marriage or adoption.
DATE / SIGNATUREG:\Hiring Packet\Cafe Monitor