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Employment Application

    Applicant Data

  15. If you are under 18 and we require a work permit, can you furnish one?

    Yes

    No

  16. Are you a U. S. citizen?

    Yes

    No

  17. If no, can you verify employment eligibility?

    Yes

    No

  18. Type of employment desired:

    Full-time

    Part Time

    Temporary

    Days

    Nights

    Weekdays

    Weekends

  19. Are you willing to work:

    Overnights

    (Live-in a few days at a time)

    Hourly

  20. Are you willing to travel?

    Yes

    No

  22. Have you ever pled “guilty” or “no contest” to or been convicted of a crime?

    Yes

    No

  24. Have you changed your name or been known by another name/alias in the last ten years?

    Yes

    No

  27. Are you covered by at least PA State Minimum Automobile Insurance?

    Yes

    No

    29. Education

  33. Did you graduate?

    Yes

    No

    G.E.D.

  41. Did you graduate?

    Yes

    No


    45. References

    63. Previous Employment

  75. May we contact this employer for a reference?

    Yes

    No

  88. May we contact this employer for a reference?

    Yes

    No

  89. Sign & Submit

    I certify that my answers are true and complete to the best of my knowledge. In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

    Yes

    No