Ebensburg

Pennsylvania

Documents

Employment Application — Full Time Employment

View original document →

Ebensburg Borough 300 West High Street Ebensburg, PA 15931

Position desired
FORMTEXT      
Date
FORMTEXT      
Date available
FORMTEXT      
Full time
FORMTEXT      
Part time
FORMTEXT      
If part time, specify days and hours per week available
FORMTEXT      

PERSONAL DATA
Name
FORMTEXT      
FORMTEXT       FORMTEXT      
Social Security number
FORMTEXT      
(Last)
(First) (Middle)

Address FORMTEXT FORMTEXT FORMTEXT FORMTEXT (Number and Street)(City)(State)(Zip Code)Email: FORMTEXT Is any additional information relative to your name necessary to enable a check on your work record? If yes, explain. FORMTEXT FORMTEXT Phone number (s) where you can be reached: FORMTEXT Are you at least 21 years of age? FORMTEXT If no, state date of birth FORMTEXT / FORMTEXT / FORMTEXT Are you a U. S. Citizen? FORMTEXT If no, are you authorized to work in the U. S. FORMTEXT

EDUCATION AND TRAINING

SCHOOL NAME AND ADDRESSDid you Graduate? DegreeMajor StudiesHigh School FORMTEXT FORMTEXT FORMTEXT FORMTEXT Business or Trade FORMTEXT FORMTEXT FORMTEXT FORMTEXT College FORMTEXT FORMTEXT FORMTEXT FORMTEXT Other (Specify) FORMTEXT FORMTEXT FORMTEXT FORMTEXT Special qualifications: (include technical and professional licenses, academic and professional awards, etc. FORMTEXT FORMTEXT

COMPUTER SKILLS
List any programs you are familiar with and your current level of knowledge:
FORMTEXT      
FORMTEXT      
FORMTEXT      

EMPLOYMENT RECORD
List all present and past employment with most recent first
Employer's name
FORMTEXT      
From
FORMTEXT      
To
FORMTEXT      
Address
FORMTEXT      
Type of business
FORMTEXT      
FORMTEXT      
Phone
FORMTEXT      
Salary
FORMTEXT      

FORMTEXT      

(Area Code) (Number)
(Starting) (Ending)
Name and title of supervisor
FORMTEXT      
Your job title
FORMTEXT      
Reason for leaving
FORMTEXT      
Briefly describe the nature and duties of your position
FORMTEXT      
FORMTEXT      
FORMTEXT      
May we contact your present employer?
FORMTEXT      

Employer's name
FORMTEXT      
From
FORMTEXT      
To
FORMTEXT      
Address
FORMTEXT      
Type of business
FORMTEXT      

Phone
FORMTEXT      
Salary
FORMTEXT      

FORMTEXT      

(Area Code) (Number)
(Starting) (Ending)
Name and title of supervisor
FORMTEXT      
Your job title
FORMTEXT      
Reason for leaving
FORMTEXT      
Briefly describe the nature and duties of your position
FORMTEXT      
FORMTEXT      
FORMTEXT      

Employer's name
FORMTEXT      
From
FORMTEXT      
To
FORMTEXT      
Address
FORMTEXT      
Type of business
FORMTEXT      

Phone
FORMTEXT      
Salary
FORMTEXT      

FORMTEXT      

(Area Code) (Number)
(Starting) (Ending)
Name and title of supervisor
FORMTEXT      
Your job title
FORMTEXT      
Reason for leaving
FORMTEXT      
Briefly describe the nature and duties of your position
FORMTEXT      
FORMTEXT      
FORMTEXT      

Employer's name
FORMTEXT      
From
FORMTEXT      
To
FORMTEXT      
Address
FORMTEXT      
Type of Business
FORMTEXT      

Phone
FORMTEXT      
Salary
FORMTEXT      

FORMTEXT      

(Area Code) (Number)
(Starting) (Ending)
Name and title of supervisor
FORMTEXT      
Your job title
FORMTEXT      
Reason for leaving
FORMTEXT      
Briefly describe the nature and duties of your position
FORMTEXT      
FORMTEXT      
FORMTEXT      

Employer's name
FORMTEXT      
From
FORMTEXT      
To
FORMTEXT      
Address
FORMTEXT      
Type of business
FORMTEXT      

Phone
FORMTEXT      
Salary
FORMTEXT      

FORMTEXT      

(Area Code) (Number)
(Starting) (Ending)
Name and title of supervisor
FORMTEXT      
Your job title
FORMTEXT      
Reason for leaving
FORMTEXT      
Briefly describe the nature and duties of your position
FORMTEXT      
FORMTEXT      
FORMTEXT      

UNEMPLOYMENT RECORD
Account for periods of unemployment of one month duration or more in the past 5 years
From
To
Reason for Unemployment
Month
Year
Month
Year

FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      

Have you ever been dismissed or asked to resign from any position? FORMTEXT If yes, give details in space provided on back page. Have you ever been convicted of any crime in a court of law? FORMTEXT If yes, give details below in space provided (excluding minor traffic violations). Criminal record will not necessarily exclude you from employment. FORMTEXT FORMTEXT

If employed, what length of time do you expect to reside in this area?
FORMTEXT      

REFERENCES
Do not list relatives, only persons who can provide employment, education or character references

Name
FORMTEXT      
Occupation
FORMTEXT      
Address
FORMTEXT      
Phone
Home
FORMTEXT      
FORMTEXT      
Office
FORMTEXT      
Name
FORMTEXT      
Occupation
FORMTEXT      
Address
FORMTEXT      
Phone
Home
FORMTEXT      
FORMTEXT      
Office
FORMTEXT      
Name
FORMTEXT      
Occupation
FORMTEXT      
Address
FORMTEXT      
Phone
Home
FORMTEXT      
FORMTEXT      
Office
FORMTEXT      
Use this space to describe your interest in the position, to summarize any additional information necessary to describe your full qualifications, and to explain answers to previous questions as noted on previous pages.
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      
FORMTEXT      

PUBLIC WORKS DEPARTMENT APPLICANTS ONLYDo you have a Pennsylvania commercial driver's license? FORMTEXT FORMCHECKBOX Yes FORMCHECKBOX NoHave you had any past experience in driving a truck? FORMCHECKBOX Yes FORMCHECKBOX No If yes, state experience and type of truck. FORMTEXT FORMTEXT Have you had any past experience in driving heavy equipment or operating heavy equipment? FORMCHECKBOX Yes FORMCHECKBOX No If yes, state experience and type of truck. FORMTEXT FORMTEXT Are you willing to work odd hours, for example 2 a. m. to 10 a. m. FORMCHECKBOX Yes FORMCHECKBOX NoWill you be available at any hour for emergency work? FORMCHECKBOX Yes FORMCHECKBOX NoCan you be conveniently reached by telephone? FORMCHECKBOX Yes FORMCHECKBOX NoDo you have a reliable means of transportation to place of employment regardless of the time of day? FORMCHECKBOX Yes FORMCHECKBOX NoHow many miles do you live from Ebensburg? FORMTEXT Do you understand that this job requires outside work in all kinds of weather, such as rain, snow, sleet as well as hot and cold weather? FORMCHECKBOX Yes FORMCHECKBOX NoAre you willing to perform all types of physical labor including pick and shovel work, sewer cleaning, snow removal, etc. FORMCHECKBOX Yes FORMCHECKBOX No

SIGNATURE
I understand that this employment application shall be considered valid for a period of time not to exceed (90) days. If I still desire a position with Ebensburg Borough after this employment application expires, it will be my duty to complete a new employment application and file it with the Borough. The facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that, if employed, false statements on this application shall be sufficient cause for dismissal. I also understand that to qualify for employment, I may be subject to a background investigation and a medical examination.

Signed
FORMTEXT      
Date
FORMTEXT      

Ebensburg Borough does not discriminate on the basis of race, color, religion, national origin, sex, age or disability as defined by law.

← Back to Documents