Do you wish to claim Veterans Preference? (Proof of Honorable Discharge Required)YesNo
Special Employment Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals with Physical or
Government contractors are subject to Section 402 of the Vietnam Era veterans Readjustment Act of 1974, which
requires that they take affirmative action to employ and advance in employment qualified disabled veterans and
veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires
government contractors to take affirmative action to employ and advance in employment qualified handicapped
If you are a disabled veteran, or have a physical or mental disability, you are invited to volunteer this information. The
purpose is to provide information regarding proper placement and appropriate accommodation to enable you to
perform the job in a proper and safe manner. This information will be treated as confidential. Failure to provide this
information will not jeopardize or adversely affect any consideration you may receive for employment.
If you wish to be identified, please sign below.
Disabled Individual Disabled Veteran Vietnam Era Veteran
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 County
of Berks 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 hereby authorize the County of Berks to thoroughly investigate my references, work records, education, criminal history, and
other matters related to my suitability for employment and, further, authorize my current and former employers to disclose to
the company any and all letters, reports and other information pertaining to my employment with them, without giving me
prior notice of such disclosure. In addition, I hereby release the County of Berks my current and former employers, and all
other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in
any way related to such investigation or disclosure.
I understand that if offered employment, the offer is contingent on my passing a pre-employment alcohol and drug screen and
a pre-employment ph
ysical. By signing this application, I voluntarily agree to submit to a pre-employment alcohol/drug
screen and pre-employment physical upon receipt of a verbal offer of employment. I understand that failure to pass the
alcohol/drug screen and/or physical will result in withdraw of the employment offer.
I certify that the answers given herein are true and complete to the best of my knowledge.
In the event of employment, I understand that false or misleading information given in
my application or interview(s) may
result in discharge. I also understand, that if hired, I will be required to abide by all rules and regulations of the County.
Signature of Applicant
AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER M/F/V/D
Berks County complies with the Drug-Free Workplace Act of 1989