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Mailing Address

Actual address (if different from mailing address above).

See the INSTRUCTIONS tab or click here for further information regarding this program.

IMPORTANT

You MUST upload a copy of one of the following approved SAME eligibility documents:

Schedule A hiring letter
-- OR --
Schedule B NJ letter for NJ Designated State Agencies
-- OR --
Schedule B NJ Letter for NJ Licensed Medical Providers
-- OR --
Social Security Administration (SSA) Approved Eligibility Letter
-- OR --
US Department of Veteran Affairs Service Connected Approved Eligibility Letter

NOTE: there is an upload button specifically for this document in the ATTACHMENTS section of this form.

Please list all vocational, technical, correspondence schools, collegs and universities you have attended. Upon employment be prepared to provide supporting documentation of schools attended. Attach additional sheets if necessary. Check the highest grade of school you have completed.

CLICK 'SELECT FILES' BUTTON OR DRAG-N-DROP ATTACHMENTS.

NOTE: IF USING DRAG-N-DROP, PLEASE DROP FILE TO 'SELECT FILES' BUTTON.
YOU CANNOT DROP FILE ANYWHERE ON THE PAGE.  IT MUST BE DRAGGED TO THE BUTTON.

Use the button below to upload your SAME Program eligibility document. 
Only one (1) such document is required; preferably in PDF format.

I understand that if I plan to engage in other business or employment while working for the State in any of its Departments or Agencies, prior approval will be necessary before accepting employment since there may be restrictions in accordance with the New Jersey Conflicts of Interest Law and/or the State, Department or Agency Code of Ethics.

I authorize my former employers to release any information they may have concerning my employment record and I release the State of New Jersey and all previous employers listed above from all liability whatsoever that may issue from securing this information. I further authorize representatives of this agency to verify any and all information contained in this application, including education, and to review any and all criminal history, military and disciplinary records of any source.

I CERTIFY that the information on this application is complete and accurate, to the best of my knowledge. I understand that any misleading or incorrect information may render this application void and be just cause for immediate termination if employed.

The State of New Jersey seeks to increase the richness and diversity of its workforce and in doing so become the employer of choice for all people seeking to work in State government. In order to judge the effectiveness of our efforts to attract and employ a diverse workforce, as well as comply with Federal and State reporting requirements, we ask that you take the time to answer a few brief questions.

This form is not part of your application for employment and will not be considered in any hiring decision. Any information submitted on this form will be considered confidential and will be filed separately by the agency’s affirmative action officer.

The State of New Jersey is an equal opportunity employer. The New Jersey State Policy Prohibiting Discrimination in the Workplace provides that applicants for employment are considered without regard to race, creed, color, national origin, nationality, ancestry, sex/gender, affectional or sexual orientation, gender identity or expression, age, marital status, civil union status, domestic partnership status, familial status, religion, atypical heredity cellular or blood trait, genetic information, liability for service in the Armed Forces of the United States or disability.

Notes Here.

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