Fillable MONROE COUNTY, PA Application for Employment (Monroe County)

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MONROE COUNTY, PA Application for Employment (Monroe County)

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Country of origin: US
File type: PDF

U.S.A. forms for Monroe County

BROWSE MONROE COUNTY (PA) FORMS

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MONROE COUNTY, PA
Application for Employment
MONROE COUNTY, PA CONSIDERS APPLICANTS FOR ALL POSITIONS WITHOUT REGARD TO RACE, CREED,
COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF ANY
DISABILITY, OR ANY OTHER LEGALLY PROTECTED STATUS. EQUAL OPPORTUNITY EMPLOYER, M/F/H/V.
PLEASE PRINT OR TYPE LEGIBLY.
DATE OF APPLICATION:
Position(s) applied for:
Seeking:
Full-time
Part-time
Other
Date Available:
Have you ever been employed by Monroe County?
Yes
No
If yes, date
Applicant’s Name:
First
Last
Ml
Address:
(include: City, State and Zip Code)
E-mail address
Cell Phone #
Telephone (include area code):
Social Security #:
Are you:
Under 18 years of age
Over 18 years of age
(Note: Applicants for positions as Correction Officers at the Monroe County Correctional Facility and/or Deputy Sheriff in the Monroe
County Sheriff’s Office must be at least 21 years of age.)
Are you a veteran of the U.S. Military Service?
Branch
Yes
No
Are you legally employable under the U.S. Immigration Laws?
Yes
No
Can you travel if job requires?
Yes
No
Do you have adequate transportation to be able to report to work as
required by the job?
Yes
No
Have you ever been convicted of a felony or a misdemeanor?
Yes
No
If yes, describe in full including dates; such convictions may be relevant if job related, but may not necessarily
disqualify applicant from employment.
Prior Employment Experience
Starting with your present/most recent job, list positions or assignments held for the last 10 years - if more than five
previous employers, use the available space on the back of this application form
. Fill out work history section
completely. DO NOT write in “See Résumé”.
May we contact your current or previous employers?
Yes
No
Initial here:
1
Employer:
Address:
Phone:
Job Title:
Employed From:
To:
Salary Start:
End:
Supervisor’s Name:
Reason for leaving:
Duties and Responsibilities:
2
Employer:
Address:
Phone:
Job Title:
Employed From:
To:
Salary Start:
End:
Supervisor’s Name:
Reason for leaving:
Duties and Responsibilities:
3
Employer:
Address:
Phone:
Job Title:
Employed From:
To:
Salary Start:
End:
Supervisor’s Name:
Reason for leaving:
Duties and Responsibilities:
4
Employer:
Address:
Phone:
Job Title:
Employed From:
To:
Salary Start:
End:
Supervisor’s Name:
Reason for leaving:
Duties and Responsibilities:
5
Employer:
Address:
Phone:
Job Title:
Employed From:
To:
Salary Start:
End:
Supervisor’s Name:
Reason for leaving:
Duties and Responsibilities:
Education History
SCHOOL NAME & LOCATION
# OF YEARS
ATTENDED
GRADUATED
COURSE OF STUDY
OR DEGREE
Yes No
HIGH SCHOOL
COLLEGE/UNIVERSITY
GRAD./PROF. SCHOOL
(or 2
nd
College/Univ.)
TRADE/BUSINESS
SCHOOL
OTHER
List trade or professional organizations of which you are a member, including offices held (you may exclude those that
would reveal sex, race, religion, national origin, age, ancestry, handicap or other protected status).
List additional skills, education and/or training which pertains to the position(s) applied for.
References
Give Names, Addresses and Phone Numbers of three (3) Personal References (not related to you).
NAME ADDRESS AREA CODE & PHONE NO.
Revised: May 2018
Applicant’s Statement
I understand the County of Monroe requires a criminal background check prior to commencing any work if I should accept
an offer of employment for any County opening in which I may be considered. I further understand if a job offer is made,
employment may be contingent upon the successful completion and passage of a medical exam.
I authorize a thorough investigation of all statements contained in this application (and accompanying resume, if any). I
also authorize Monroe County to contact my present employer (unless otherwise noted in this application form), past
employers, educational institutions and any or all references listed without giving me prior notice of such disclosure. I
hereby release the County of Monroe and their representatives from any and all liabilities arising out of or in any way
related to such investigation or disclosure.
I authorize any person, school, current or previous employer, and organizations named in this application form (and
accompanying resume, if any) to provide Monroe County with relevant information and opinion (including, but not limited
to Personnel file materials, disciplinary materials and performance evaluations) that may be useful to Monroe County in
making a hiring decision, and I release such persons and organizations from any legal liability in making such statements.
I understand that neither this document nor any offer of employment from Monroe County constitute an employment
contract. I also understand that if I am hired, either Monroe County or I may terminate my employment with Monroe
County at will for any or no reason, at any time.
I understand that if my employment is terminated by Monroe County for dishonesty, breach of trust, or any criminal acts,
the authorities may be notified and I may be criminally prosecuted. I also understand that, if hired, I may not hold other
employment, nor engage in sales, investments or other activities that create a conflict of interest with my position with
Monroe County.
I certify that the information provided in this employm
ent application (and accompanying resume, if any) is true and
complete, and I understand that any false information or significant omissions may disqualify me from further
consideration for employment, and may result in my dismissal from employment, if discovered at a later date. I agree to
immediately notify Monroe County if I should be convicted of a felony, or any crime involving dishonesty or a breach of
trust while my job application is pending, or during my employment with Monroe County, if hired.
My typed name has the same force and effect as my written signature.
Signature of Applicant
Date
This application for employment shall be considered active for a period of six (6) months and will remain on file for two
(2) years.
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MONROE COUNTY, PA Application for Employment (Monroe County)

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Completed 18 July 2020

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