APPLICATION FORM THE SENIOR EXECUTIVE SERVICE STATE OF NEW JERSEY

Transcription

1 APPLICATION FORM THE SENIOR EXECUTIVE SERVICE STATE OF NEW JERSEY PREFACE In order to build an information base that will capture relevant facts about members and potential members in the Senior Executive Service (SES), this application is comprehensive. As a supplement to this process, you are required to include a copy of your resume with this application. You may wish to update your application periodically by sending relevant information to include in your file. You may also respond to positions posted in the future that you are interested in and request that your application or file be utilized for selection review. If you wish, you may submit and update your application electronically. At present, the Department of Labor & Workforce Development can accept an electronic application. Additional SES applications are available from: Recruitment Unit ( ) Office of Human Resources John Fitch Plaza, PO Box 044 Trenton, NJ DPF-556(modified for NJDLWD 5/15)

2 Applicant s Social Security Number (S.S.N.): THE NEW JERSEY SENIOR EXECUTIVE SERVICE APPLICATION FOR THE NJ DEPARTMENT OF LABOR PART A PERSONAL INFORMATION Last Name: First: Middle: Current Resident: Phone (Residency): (Work): List Department position(s) for which you are applying: Position(s):

3 PART B DEVELOPMENTAL PROFILE S.S.N.: Name and Location of Educational Institutions Attended Dates Attended Major Type of Degree Year Degree Awarded Other significant education/training related to the job for which you are applying: Licensure, certification, other credentials (if any) related to the job for which you are applying: Please state any additional skills, accomplishments, experiences, or awards which would enhance your success in the SES: Please state any professional memberships and offices held:

4 PART C EMPLOYMENT PROFILE (CURRENT) S.S.N.: INSTRUCTIONS: Starting with your most recent or current job, describe each position held. Any substantive change in title with the same employer should be considered a new job. Include non-paid, volunteer work, if it is related to the job for which you are applying. Current, or most recent Employer: Name: Address: Department/Division/Bureau or Section of State Government: Your Title: Type of business or activity: Dates Employed (if part time, hours per week): Immediate Supervisor (Name/Title): Number and Title(s) of Employees Supervised: Current Salary: Discussion (e.g., Responsibilities/Accomplishments, using additional space as necessary):

5 PART D EMPLOYMENT PROFILE (PAST) S.S.N.: Please repeat this portion as many times as necessary to report employment over the past ten years; or additional years, if you think more than ten years is relevant. Past Employer: Name: Address: Department/Division/Bureau or Section of State Government: Your Title: Type of business or activity: Dates Employed (if part time, hours per week): Immediate Supervisor (Name/Title): Number and Title(s) of Employees Supervised: Highest Salary: Discussion (e.g., Responsibilities/Accomplishments, using additional space as necessary):

6 PART D EMPLOYMENT PROFILE (PAST) S.S.N.: Please repeat this portion as many times as necessary to report employment over the past ten years; or additional years, if you think more than ten years is relevant. Past Employer: Name: Address: Department/Division/Bureau or Section of State Government: Your Title: Type of business or activity: Dates Employed (if part time, hours per week): Immediate Supervisor (Name/Title): Number and Title(s) of Employees Supervised: Highest Salary: Discussion (e.g., Responsibilities/Accomplishments, using additional space as necessary):

7 PART D EMPLOYMENT PROFILE (PAST) S.S.N.: Please repeat this portion as many times as necessary to report employment over the past ten years; or additional years, if you think more than ten years is relevant. Past Employer: Name: Address: Department/Division/Bureau or Section of State Government: Your Title: Type of business or activity: Dates Employed (if part time, hours per week): Immediate Supervisor (Name/Title): Number and Title(s) of Employees Supervised: Highest Salary: Discussion (e.g., Responsibilities/Accomplishments, using additional space as necessary):

8 PART D EMPLOYMENT PROFILE (PAST) S.S.N.: Please repeat this portion as many times as necessary to report employment over the past ten years; or additional years, if you think more than ten years is relevant. Past Employer: Name: Address: Department/Division/Bureau or Section of State Government: Your Title: Type of business or activity: Dates Employed (if part time, hours per week): Immediate Supervisor (Name/Title): Number and Title(s) of Employees Supervised: Highest Salary: Discussion (e.g., Responsibilities/Accomplishments, using additional space as necessary):

9 PART D EMPLOYMENT PROFILE (PAST) S.S.N.: Please repeat this portion as many times as necessary to report employment over the past ten years; or additional years, if you think more than ten years is relevant. Past Employer: Name: Address: Department/Division/Bureau or Section of State Government: Your Title: Type of business or activity: Dates Employed (if part time, hours per week): Immediate Supervisor (Name/Title): Number and Title(s) of Employees Supervised: Highest Salary: Discussion (e.g., Responsibilities/Accomplishments, using additional space as necessary):

10 PART D EMPLOYMENT PROFILE (PAST) S.S.N.: Please repeat this portion as many times as necessary to report employment over the past ten years; or additional years, if you think more than ten years is relevant. Past Employer: Name: Address: Department/Division/Bureau or Section of State Government: Your Title: Type of business or activity: Dates Employed (if part time, hours per week): Immediate Supervisor (Name/Title): Number and Title(s) of Employees Supervised: Highest Salary: Discussion (e.g., Responsibilities/Accomplishments, using additional space as necessary):

11 PART E MOBILITY INTERESTS S.S.N.: The information in this section may be used to notify candidates of future opportunities. A. Are you interested in participating in focus groups, on task forces, and/or in mobility assignments on cross-cut issues and/or direct line management responsibilities? Yes No B. If yes, list up to five topics and/or occupational fields in priority order in which you are particularly interested. a. b. c. d. e. C. Please feel free to offer any additional comments or observations about this section.

12 PART F REFERENCES S.S.N.: List Name, Title, Address, Phone Number for persons in each of the following categories who may be contacted to detail why they would recommend you for the Senior Executive Service (SES): A. Three executives/top managers who have worked with you. B. One employee who formerly reported to you (title then, title now). C. One colleague/professional peer.

13 PART G Instructions In narrative (essay) form, please indicate why you wish to join the New Jersey Senior Executive Service (SES) and how you think you will be able to contribute to the SES, generally; and, specifically, in the New Jersey Department of Labor. Additionally, please feel free to include a list of relevant work-related publications or presentations that you feel might enhance your application. Selected samples of such supplements need not be submitted (reproduced) electronically but may be provided in hard copy, if you wish. Most narratives will range from 500 to 1,500 words. Please feel free to organize your essay in any way you think appropriate and include any topics that you think are relevant. The following are suggested areas you might cover in your narrative: Your understanding of the SES and your ability to contribute Administrative problem-solving ability (describe approaches to problem-solving and decision-making, citing career examples) Commitment to public service Commitment to and interest in EEO/AA by past accomplishments Accountability, leadership, and acting in the best interest of broad management objectives Managerial competence or potential in terms of operational, budgetary, and staff development skills Projection of human resource requirements for a specific project or program Technical competence Intra-organizational coordinating abilities Inter-organizational coordinating abilities Ability to work collaboratively with superiors and subordinates Short/long range professional goals and how they relate to participation in SES Professional accomplishments, successfully completed projects, commendations and specific recognition (i.e., selective highlighting of your resume)

14 PART G NARRATIVE S.S.N.:

15 PART H EEOC INFORMATION S.S.N.: (Completion of this information is mandatory but will be used only for compliance with EEOC Guidelines and the New Jersey State Affirmative Action Program) Male Female Indicate EEO category to which you belong: White (non-hispanic) Black (non-hispanic) Hispanic Asian or Pacific Islander American Indian/Alaskan Native PART I During the past ten years, were your employment services terminated involuntarily; did you resign following advice that your employment would be terminated; or did you resign by virtue of mutual agreement resulting from an employment issue? If yes, please use additional sheets to explain for each applicable employer. Yes No PART J CERTIFICATION AND RELEASE OF INFORMATION I certify to the best of my knowledge that all of the above statements are correct, complete and made in good faith. I understand that a false statement on this application may be grounds for refusing me an appointment or terminating my employment. I consent to the release of information concerning my background, abilities, and fitness for this position by employers, education/training institutions, law enforcement agencies and other individuals/organizations, to authorized agents of State government and to the press if I am appointed to an SES position. Name/Signature (on hard copy) Date