APPLICATION FOR EMPLOYMENT -

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Phone: 814.781.7333

APPLICATION FOR EMPLOYMENT

Application for Employment

Name
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone number
Mobile phone number
Email*
In case of emergency, notify:
Emergency Phone Number
If you are under 18, can you furnish a work permit?
- No
- Yes
Why not?
Position(s) applying for
Data available to start work
MM slash DD slash YYYY
What is your desired hourly rate of pay?
Type of employment
- Full-time (40 hours per week)
- Part-time
- Seasonal
Hours per week available to work
Can you work overtime if needed?
- Yes
- No
Have you submitted an application here before?
- Yes
- No
List any relatives or friends working for us
Have you ever been employed here before?
- Yes
- No
Please provide date(s) and position(s)
Are you a U.S. citizen or otherwise authorized to work in the U.S. on a restricted basis?
(If hired you will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require a completed I-9 Form)
- Yes
- No
Education Background
Start with the most recent school attended and complete the following information:
School #1
School Name
Years completed
City
State
Course of study
Earned
- HS Diploma / GED
- Degree
- Certification
Please specify your degree
Please specify your Certification
List any special training, skills, licenses, and/or qualifications that we should know about
References
List three references who are not related to you. Please provide Name, Profession, Phone #, and number of years known.
Reference #1
Full Name
Profession
Phone
Years Known
Please enter a number greater than or equal to 0.
Work Experience
Start with most recent employer and complete the following information:
Experience #1
Company Name
Phone number
Address
Street Address
Starting Wage per hour
Please enter a number greater than or equal to 0.
Ending Wage per hour
Please enter a number greater than or equal to 0.
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Reason for Leaving (be specific)
Summarize the work performed, skills used, and job responsibilities while you worked for this employer
Name of Supervisor
May we contact the above employer?
- Yes
- No
Why not?
Any additional job-related information you want us to know about
Have a resume? Upload it here.
Max. file size: 50 MB.

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259 Eberl Street, St. Marys, Pennsylvania 15857
Phone: 814.781.7333 – Fax: 814.834.9201

Contact

259 Eberl Street, St. Marys, Pennsylvania 15857 Phone: 814.781.7333 - Fax: 814.834.9201 [email protected]

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