Fillable EMPLOYMENT APPLICATION HUMAN RESOURCES Montgomery County Courthouse PO (Montgomery County Pennsylvania )

Fill Online, Printable, Fillable, Blank EMPLOYMENT APPLICATION HUMAN RESOURCES Montgomery County Courthouse PO (Montgomery County Pennsylvania ) Form

Use Fill to complete blank online MONTGOMERY COUNTY PENNSYLVANIA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

EMPLOYMENT APPLICATION HUMAN RESOURCES Montgomery County Courthouse PO (Montgomery County Pennsylvania )

On average this form takes 35 minutes to complete

The EMPLOYMENT APPLICATION HUMAN RESOURCES Montgomery County Courthouse PO (Montgomery County Pennsylvania ) form is 5 pages long and contains:

  • 0 signatures
  • 15 check-boxes
  • 132 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Montgomery County Pennsylvania forms online.

BROWSE MONTGOMERY COUNTY PENNSYLVANIA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
EMPLOYMENT APPLICATION
Please Type or Print
Date _______________________________
Please read a
ll four (
4) pages of this application and complete fully. An incomplete application will be returned to you.
The ORIGINAL Application MUST be returned to Human Resources.
Name _________________________________________________________________________________________________________________________________________
(Last) (Initial)
(First)
Address _______________________________________________________________________________________________________________________________________
(Street)
(State) (Zip Code)
(City)
Telephone number (including area code): ___________________________ ONLY if under the age of 18, state your date of birth: _________
_______________
E-mail Address: _________________________________________________________________________
Are you a U.S. Citizen?
Yes No No If not, can you furnish proof of Visa or Immigration Status? Yes
Type of employment wanted:
Full-time Part-time Temporary Summer Shift____________________
Date available to start if hired: __________________________________________
Position(s) ____________________________________________________________________ Salary Expected: $______________________________
applied ____________________________________________________________________ Salary Expected: $______________________________
for ____________________________________________________________________ Salary Expected: $______________________________
Have you ever been employed by Montgomery County?
Yes No
When ________________ Department _________________ ________________________
Can you assure a reliable means of transportation to get to work? (If position requires)
Yes No
Do you have a valid PA Driver's License?
Yes No
Class of License:
___________________________
Are you related to anyone who works for the County?
Yes No (If yes, complete the following):
Department: __
Name: __
Name: __
Relationship: ___
Relationship:
________
Department: ________
___
_________________________________
_________________________________
_____
____
________________________
_____________________________
_____
____
_____________________
_______________
__
_
___
_
Please list below any skills, qualifications or experiences, which you feel would especially fit you for work with the County:
________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
How did you learn of the position(s) for which you are applying? ___________________________________________________________________________
________________________________________________________________________________________________________________________________________________
Montgomery County complies with the Civil Rights Act of 1964 prohibiting discrimination in employment practice because of race, color, religion,
sex or national origin; PL 90-202 prohibiting discrimination because of age, and the Americans with Disabilities Act of 1992, prohibiting
discrimination against the handicapped in employment or the provision of services. Further, the County complies with all applicable provisions of
the Pennsylvania Criminal History Record Information Act.
It is the policy of Montgomery County to prohibit discrimination and harassment of any type and to afford equal employment opportunities to
current employees and applicants, without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status,
marital status, sexual orientation, gender identity or expression, pregnancy or political affiliations.
Montgomery County is an equal opportunity employer
If you need help to fill out this application form or during any phase of the application, interview, or employment process, please contact Human Resources or the Hiring Manager of the department.
_________________________________________________________________________________________________________________________________________________
HUMAN RESOURCES
Montgomery County Courthouse • PO Box 311
Norristown, PA 19404-0311
610-278-3052
fax: 610-292-2160
www.MontcoPA.org
MONTGOMERY COUNTY
BOARD OF COMMISSIONERS
VALERIE A. ARKOOSH, MD, MPH. Chair
KENNETH E. LAWRENCE JR., Vice Chair
JOSEPH C. GALE, Commissioner
MILITARY RECORD
If you served in the U.S. Armed Forces, please list your dates of active service: From ________________________________ to _______________________________
Were you honorably discharged? Yes No A copy of your DD For
m 214 must be attached.
Branch of Service (please check appropriate box): Army Navy Marines Air Force Coast Guard
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
RECORD OF EDUCATION
________________________________________________________________________________________________________________________________________________
If you are applying for a position, which requires a degree, you must attach proof of your educational background to this application. If hired this proof will become a
permanent part of your personnel file.
________________________________________________________________________________________________________________________________________________
SCHOOLS
ATTENDED
Circle Highest
(years) Completed
Name and Address
Earned Diploma /
Degree?
Your major / Area of concentration
High Scho
ol
1 2 3 4
1 2 3 4
Graduate
School
1 2 3 4
Other
1 2 3 4
________________________________________________________________________________________________________________________________________________
BUSINESS REFERENCES (not
relatives)
Please list below three (3
) business references, whom we may contact.
Name: _____________________________________ Position/Title: _______________________________ Telephone Number: [_________]______________
(Area Code) Phone
Company Name:____________________________________________________________________________
Company Address: _________________________________________________________________________
__________________________________________________________________________
Name: ___________________
__________________ Position/Title: _______________________________ Telephone Number: [_________]______________
(Area Code) Phone
Company Name:____________________________________________________________________________
Company Address: _________________________________________________________________________
__________________________________________________________________________
Name: ___________________
__________________ Position/Title: _______________________________ Telephone Number: [_________]______________
(Area Code) Phone
Company Name:____________________________________________________________________________
Company Address: _________________________________________________________________________
__________________________________________________________________________
_______________________________________________________________________________________________________________________________________________
2 of 4
College/
University
EMPLOYMENT RECORD
____________________________________________________________________________________________________
Please provide your employment record, below, beginning with your current or most recent employer.
____________________________________________________________________________________________________
Employer's Name:
Address:
Supervisor's Name:
May we contact? Yes No
If yes, Phone# (including area code)
Starting Date:
Leaving Date:
Reason for leaving:
Job Title:
Description of Duties:
Employer's Name:
Address:
Supervisor's Name:
May we contact? Yes No
If yes, Phone# (including area code)
Starting Date:
Leaving Date:
Reason for leaving:
Job Title:
Description of Duties:
Employer's Name: Address: Supervisor's Name:
May we contact? Yes No
If yes, Phone# (including area code)
Starting Date:
Leaving Date:
Reason for leaving:
Job Title:
Description of Duties:
3 of 4
I certify that the statements made on this application for employment are true and correct, to the best of my knowledge and I hereby grant permission for the authorities
of the
County of Montgomery to investigate and verify the information contained herein a
n
d m
y
r
e
f
e
r
e
nces and release the County of Montgomery and all previous
employers from any and all liability resulting from such investigation. Upon my separation from the County of Montgomery, I authorize the release of reference
information on my work.
I understand that the giving of false information or the failure to give complete information requested herein shall constitute grounds for rejection of my application or
my dismissal in the event of my employment by the County of Montgomery. I understand that my employment with the County of Montgomery is contingent upon the
satisfactory recommendation from former employers and references if requested.
I understand that this application for employment and any other Montgomery County documents are not contracts of employment. I also understand that
employment at the County of Montgomery is an "
at will" arrangement
and
as
such
any
individual
who
is
hired
may voluntarily leave employment upon proper
notice and may be terminated by the County of Montgomery at any time and for any reason. I understand that any oral or written statements to the
contrary are hereby expressly disavowed and should not be relied upon by any prospective employee.
Any benefits that I receive as an employee of the County may change or may be terminated at any time subject to existing federal laws and/or bargaining agreements if
applicable.
_______________________________________
________________________________________________________
(Date)
(Signature of Applicant)
_______________________________________________________________________________________________________________________________________
FOR HUMAN RESOURCES' USE ONLY
Date application was logged in: _________________________
Application logged in by: ______
________________________________
Rev. 2/2020/kht
4 of 4
Since many of the vacant positions for which you may be considered are in the Court System or deal with children (directly or indirectly) we are advising that you
may have to undergo a criminal background investigation. Therefore, we request that you read the following and acknowledge by signing in the appropriate space.
For certain positions within the County, a criminal background check or clearances will be required during the evaluation process as a condition of
employment. It is the goal of Montgomery County to hire from a broadly diverse pool of qualified applicants, including where appropriate and permitted by
law, individuals with a history of criminal convictions. As such, applicants with a criminal background will not be automatically excluded from consideration
for hire with the County.
RELEASE OF CONFIDENTIAL INFORMATION
I hereby give my permission to release to the Human Resources Office of the County of Montgomery, Pennsylvania, any records of criminal conviction, any past
employment records including performance evaluations, time and attendance records and any other personnel records and written or verbal references for
the County's review and evaluation with regard to my application for employment with the said County of Montgomery.
_______________________________________
________________________________________________________
(Date) (Signature of Applicant)
Because of the sensitivity of some County government positions, the following must be acknowledged:
I hereby acknowledge that if I am employed by Montgomery County in:
a) any Court- related or Court-appointed department
b) the County Health Department
I am required by law to refrain from all political activity. Such activity includes, but is not limited to, running for public office, serving as a political party committee person,
working at a polling place on Election Day, performing volunteer or paid work in a political campaign, soliciting political contributions, being a delegate at a political
convention and circulating political nominating petitions.
I certify that I have read and understand these prohibitions regarding political activity and promise to obey said restrictions if employed in an applicable department. I further
understand that failure to comply will result in my dismissal from County employment and/or forms of disciplinary action.
______________________________________ __________________________________________________________
(Date)
(Signature of Applicant)
Voluntary EEO Form
The data you provide is used solely for research and statistical purposes, which are required by the federal and state
government for any government entity that receives grant funding.
Race/Ethnic Category: Please Check One
Race/Ethnic designations as used by the Equal opportunity Commission do not denote scientific definitions of
anthropological origins. For the purposes of this information-gathering tool, applicants should select the group(s) with
which they identify. The following definitions are as offered by the federal government.
White (not of Hispanic origin): All persons having origins in any of the original peoples Europe,
North Africa or the Middle East.
Black (not of Hispanic origin): All persons having origins in any of the Black racial groups of Africa.
Hispanic: All persons having origins in Mexico, Puerto Rico, Cuba, Central or South America or other Spanish
speaking culture or origin, regardless of race.
Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia,
the Indian Subcontinent or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the
Philippine Islands, and Samoa.
American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America and
who maintain cultural identification through tribal affiliation or community recognition.
Sex
Male Female
Veteran
Yes No
We appreciate your participation.
By checking this box, I choose not to disclose the requested voluntary information.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

EMPLOYMENT APPLICATION HUMAN RESOURCES Montgomery County Courthouse PO (Montgomery County Pennsylvania )

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 15 June 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document