Employment Form

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Application For Employment

[/vc_column_text][vc_column_text]Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.[/vc_column_text][/vc_column][vc_column width=”1/3″][vc_single_image image=”8430″ img_size=”full”][vc_column_text]

3813 W 9th Street Trainer, PA 19061

610-494-9600 | 610-494-9400

Fax: 610-494-4125

Email: sburke85@gmail.com

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Personal Information

Your Name*

Date*

Address*

Phone*

Cellular*

Email Address*

If you are under 18, and it is required, can you furnish a work permit?*
YesNo

Do you have a valid drivers license?*
YesNo

Are you legally eligible for employment in this country ?*
YesNo

Employment Desired

Position applied for*

Date available for work*

Desired Salary Range

Are you employed now?*
YesNo

Have you ever been employed here before?*
YesNo

If yes, give dates and positions

Referred by

Type of employment desired?*
Full-TimePart TimeSeasonal

Have you ever pled "Guilty" or "no contest" to, or been convicted of a crime?*
YesNo

If yes, provide dates and details

Educational Background

School/College	Name and Location	Years	Did you graduate	Degree
High School
College
Trade/Other

References

People that can help validate information from the application (ie: former employers, managers, supervisors, work associates)

Name	Telephone	of Years Known	Position

People that can help validate information your character (ie: personal, friend, mentor)

Name	Telephone	of Years Known

Skills and Qualifications

Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Activities/Special Interests/Hobbies

Employment History

From	To	Employer	Phone
Job title		Address
Immediate Supervisor/Title		Summarize the nature of work and job responsibilities
YesNoLater
Hourly Rate/Salary		Reason for Leaving

From	To	Employer	Phone
Job title		Address
Immediate Supervisor/Title		Summarize the nature of work and job responsibilities
YesNoLater
Hourly Rate/Salary		Reason for Leaving

From	To	Employer	Phone
Job title		Address
Immediate Supervisor/Title		Summarize the nature of work and job responsibilities
YesNoLater
Hourly Rate/Salary		Reason for Leaving

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the employer true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, If I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and the federal immigration laws require me to complete an 1-9 form in this regard.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

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