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Borough of Greencastle
60 North Washington Street
Greencastle, PA 17225
EMPLOYMENT APPLICATION
Equal Employment Opportunity Employer
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability,
marital status, sexual orientation or any other legally protected status. Applicants requiring accommodation in the application
or hiring process should contact the Personnel Office.
(Please Print)
Position(s) Applied For
Date of Application
How Did You Learn About Us?
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Walk-In
Employment Agency
Last Name First Name Middle Name
Address City State Zip
Telephone Number(s) Social Security Number
Yes
No
If you are under 18 years of age, can you provide required proof of your eligibility to work?
Have you ever filed an application with us before? If yes, give date
Have you ever been employed with us before? If yes, give date
Are you currently employed?
May we contact your present employer?
Are you a U.S. Citizen or otherwise lawfully authorized to be employed in this country?
Proof of citizenship or immigration status will be required upon employment.
What date would you be available for work?
Are you available to work :
Full Time
Part Time
Shift Work
Temporary
Are you currently on “lay-off” status and subject to recall?
Can you travel if a job requires it?
Have you been convicted of a felony or misdemeanor? Conviction will not necessarily disqualify an applicant from employment.
If yes, please explain
Education
Do you have a General Equivalency Diploma(GED) or High School Diploma? Yes No
Name and Address
of School
Course of Study
Years Completed
Diploma
Degree
Undergraduate
College
Graduate
Professional
Other
(Specify)
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Skills & Training
Describe any specialized training, apprenticeship, skills, and
extracurricular activities.
Describe any job-related training received in the
United States Military.
Are you requesting consideration of Veteran’s status?
Yes
No
If you are, provide the following information:
Date of Discharge:
Type of Discharge:
(Verification of Veteran’s status may be required)
Employment Experience Start with your present or last job.
1.
Employer
Dates Employed
Work Performed
From
To
Address
Telephone Number(s)
Job Title
Supervisor
Reason for Leaving
2.
Employer
Dates Employed
Work Performed
From
To
Address
Telephone Number(s)
Job Title
Supervisor
Reason for leaving
3.
Employer
Dates Employed
Work Performed
From
To
Address
Telephone Number(s)
Job Title
Supervisor
Reason for Leaving
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If you need additional space, please continue on a separate sheet of paper.
List professional, trade, business, or civic activities and offices held.
You may exclude membership which reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:
Additional Information
Do you have a valid Driver’s License?__________________ /State of Issuance: ________/Driver’s License No:_____________________________
Police Dept. Applicants Only:
It is required that all Borough of Greencastle Police Officers and interested police department applicants hold a valid Act#120
(Pennsylvania Municipal Police Officers Training Commission) Certificate. Please provide your M.P.O.E.T.C number here:
______________________________________
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
State any additional information you feel may be helpful to us in considering your application.
Note to Applicants: Do not answer this question unless you have been informed about the requirements of the job for
which you are applying.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in
the job or occupation for which you have applied? ____ Yes ____ No
Y
N
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Personal References
1. Name _______________________________________________________________________________ Telephone______________________
Address __________________________________________________________________________________________________________________________
2. Name _______________________________________________________________________________ Telephone______________________
Address __________________________________________________________________________________________________________________________
3. Name _______________________________________________________________________________ Telephone______________________
Address __________________________________________________________________________________________________________________________
Professional References Do not include any individuals who are related to you.
1. Name _______________________________________________________________________________ Telephone______________________
Address __________________________________________________________________________________________________________________________
2. Name _______________________________________________________________________________ Telephone______________________
Address __________________________________________________________________________________________________________________________
3. Name _______________________________________________________________________________ Telephone______________________
Address __________________________________________________________________________________________________________________________
Applicant’s Statement
I certify that the answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at
an employment decision. I hereby authorize all current and former employers, educational institutions, and references to
release information relevant to my application for employment and I release the Borough, all current and former
employers, educational institutions, and references from any and all liability related to the release of such information.
This application for employment shall be considered active for a period of two (2) years. Any applicant wishing to be
considered for employment beyond this time period should inquire as to whether or not applications are being accepted at
that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law or collective bargaining agreement,
any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at
any time and the Employer may discharge Employee at any time with or without cause.
In the event of employment, I understand that false or misleading information given in my application or interview(s)
may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Signature of Applicant
Date