Fillable Employment ( Job) Application (Borough of Gettysburg)

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Employment ( Job) Application (Borough of Gettysburg)

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The Employment ( Job) Application (Borough of Gettysburg) form is 3 pages long and contains:

  • 3 signatures
  • 31 check-boxes
  • 123 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Borough of Gettysburg

BROWSE BOROUGH OF GETTYSBURG (PA) FORMS

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YES
C.D.L. - Class A:
C.D.L. - Class B:
First Aid:
C.P.R.:
Masonry:
Carpentry:
OTHER Certifications or Skills:
Metal Works:
Heavy Equipment Operator:
List any relatives and/or friends currently
employed by the Borough of Gettysburg:
APPLICATION FOR EMPLOYMENT or VOLUNTEER SERVICE
CERTIFICATIONS and SKILLS:
Note: Please bring proof of certifications to your interview(s).
Please print or type all requested information. Statements regarding education, employment, etc. and all references are
subject to investigation and verification. False statements may lead to discipline and/or termination if discovered after
employment. A resume may be attached, but should not replace the information requested on this form.
www.GettysburgPA.gov
SStull@GettysburgPA.gov
Email:
THE BOROUGH OF GETTYSBURG IS AN EQUAL OPPORTUNITY EMPLOYER. WE ARE DEDICATED TO A POLICY
OF NON-DISCRIMINATION EMPLOYMENT ON ANY BASIS PROTECTED BY LAW INCLUDING RACE, CREED,
COLOR, AGE, GENDER, NATIONAL ORIGIN, OR PHYSICAL HANDICAP.
Gettysburg, PA 17325
Phone Number: (717) 334-1160
FAX Number: (717) 334-7258
Apt. #
CITY
STATE
TODAY'S DATE:
PHONE NUMBERS:
−
)
ZIP CODE
LOCAL ADDRESS:
(If different from Permanent Address)
HOUSE #
STREET NAME
Apt. #
CITY
STATE
ZIP CODE
LAST
FULL
NAME:
(No P.O. Boxes)
HOUSE #
STREET NAME
FIRST
MIDDLE
−
PERMANENT ADDRESS:
DATE YOU CAN START:
SEASONAL:
PART-TIME:
FULL-TIME:
(
(
)
POSITION DESIRED:
SALARY DESIRED:
DRIVER'S LICENSE NUMBER:
STATE of ISSUANCE:
Are you legally permitted to work in the United States:
YES
NO
MOBILE (CELL) NUMBER
EMAIL ADDRESS:
HOME NUMBER
Any disabilities that would prevent you from performing the duties of the job or any
ADA accommodations that we should know about?
IF YES, please explain on separate paper.
YES
NO
YES
NO
Are you available on weekends?
YES
NO
Are you employed now?
List any additional skills or certifications you have:
OTHER
GRAD
SCHOOL
TECH
SCHOOL
COLLEGE
YEARS
ATTENDED
MAJOR COURSES
EDUCATION:
HIGH
SCHOOL
WORK HISTORY:
(List the last four employers, Starting with the present or most recent)
FROM:
FROM:
NAME:
$
ADDRESS:
Per
POSITION
Supervisor:
May we contact?
YES
NO
(MONTH & YEAR)
TO:
Phone #:
Supervisor:
May we contact?
YES
NO
DATE:
SALARY
NAME:
$
ADDRESS:
Per
TO:
Phone #:
Supervisor:
May we contact?
YES
REASON FOR LEAVING
FROM:
NAME:
$
ADDRESS:
Per
TO:
Phone #:
NO
Dates (month/year) of Military Service (Active & Reserve):
Type of Discharge:
List Military Awards:
If YES: Branch
of Service:
MILITARY EXPERIENCE:
Are you a veteran?
YES
NO
FROM:
NAME:
$
ADDRESS:
Per
TO:
Phone #:
Supervisor:
May we contact?
YES
NO
OCCUPATION:
NAME:
COMPLETE ADDRESS:
PHONE NUMBER:
OCCUPATION:
MISCELLANEOUS:
List any activities or special awards:
List three (3) persons not related to you and not listed as previous employers. These references should be
familiar with your background and character.
REFERENCES:
NAME:
COMPLETE ADDRESS:
PHONE NUMBER:
OCCUPATION:
NAME:
COMPLETE ADDRESS:
PHONE NUMBER:
List any subjects of special study or research:
List any other special training(s) you may have:
NAME:
COMPLETE ADDRESS:
PHONE NUMBER:
EMERGENCY CONTACT INFORMATION:
In case of emergency, notify:
I authorize investigation of all statements made in this application. I understand that misrepresentation or omission of facts called for is
cause for dismissal. I also authorize a criminal background investigation of myself - this includes a background investigation of my driving
history. Further, I understand and agree that my employment is for no definite period and may, at the discretion of the employer, be
terminated at any time without any previous notice, subject to terms and conditions of any bargaining unit agreements with the Borough of
Gettysburg (if the employee is covered by a bargaining unit).
TO BE COMPLETED BY
PARENT/GUARDIAN OF
MINOR CHILDREN:
I give consent to the investigation and
drug/alcohol testing outlined in this
employment application of my child.
SIGNED:
DATE:
SIGNED:
DATE:
I understand that the Borough of Gettysburg has a zero tolerance policy regarding substance abuse and has a stringent drug/alcohol policy
in place. I understand that all job applicants and/or new employees may be required to comply with drug testing protocols as outlined by
law. Such tests may be required without prior notification and may be requested at random with cause' for the presence of alcohol and/or
drugs in my body. I acknowledge that a confirmed positive test may cause me not to be hired or to be removed from the payroll and subject
to discipline up to and including termination, or with a recommendation to attend a drug/alcohol rehabilitation program. I fully
understand that if I should refuse to take the test, I will not be hired, or I could be suspended from my job without pay or be terminated for
insubordination. I also understand that the test results will be held in confidence and handled by authorized management personnel.
I hereby consent ( ______ ) or refuse ( ______ ) to take the drug/alcohol test.
I acknowledge that this document (or any accompanying document executed or delivered pursuant to or in connection with the
drug/alcohol policy) is not intended to confer any contractual or other rights or claims in my favor (and that I remain employed at will).
SIGNED:
DATE:
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Employment ( Job) Application (Borough of Gettysburg)

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Completed 16 July 2020

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