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Muhlenberg Township Application for Employment

2. An Equal Opportunity Employer
   Please Note: Complete all parts of the application by printing or typing. If you have no information to enter in a section, please write N/A. Return completed applications to:<br>Human Resources<br>Muhlenberg Township<br>210 George Street<br>Reading, PA 19605

   Please Note: Complete all parts of the application by printing or typing. If you have no information to enter in a section, please write N/A. Return completed applications to:
   Human Resources
   Muhlenberg Township
   210 George Street
   Reading, PA 19605

4. First Name

5. Middle Name

6. Last Name

8. Address

10. City

11. State

12. Zip Code

14. Temporary Address

16. City

17. State

18. Zip Code

20. Cell Phone

21. Evening Phone

22. Email Address

24. Are you 18 years of age or older?

    1. Yes

    1. No

25. Do you have relatives currently working for Muhlenberg Township?

    1. Yes

    1. No

27. If Younger Than 18, List Birth Date
    If Younger Than 18, List Birth Date

28. List Department

30. Employment Desired

    1. Full Time
    2. Part Time
    3. Seasonal

31. Position Applied For

33. Can you perform the essential functions of the position that you are applying for?

    1. Yes

    1. No

34. Date You Are Available
    Date You Are Available

36. Are you employed now?

    1. Yes
    2. No

37. Do you object to working overtime?

    1. Yes
    2. No

38. Can you work overtime without prior notice?

    1. Yes
    2. No

42. Education & Training History

44. High School Address

46. City

47. State

48. Zip Code

50. Year Diploma or GED Was Received

    Graduation year is used for verification purposes only.

51. Mark the Highest Level of Education Completed

    1. Some High School
    2. High School/GED
    3. Associate

    1. Bachelor
    2. Master
    3. Doctoral

53. College/University Attended

54. Major Course of Study

55. Degree (if Any) and Year Received

57. College/University Attended

58. Major Course of Study

59. Degree (if Any) and Year Received

61. College/University Attended

62. Major Course of Study

63. Degree (if Any) and Year Received

65. Other Education Completed/Certifications, Licenses, Etc.

    The information provided should directly relate to the duties of the position for which you are applying.

67. Do you have a valid driver’s license?

    1. Yes

    1. No

68. Do you have a valid Commercial Driver’s License?

    1. Yes

    1. No

70. State & Expiration Date

74. Have you served in the U. S Armed Forces, including the U.S. Reserve or State Guard?

    1. Yes

    1. No

76. Branch

77. Date Entered
    Date Entered

78. Date Discharged
    Date Discharged

80. Highest Rank

81. Nature of Duties & Responsibilities

83. Do you claim Veteran’s Preference?

    1. Yes

    1. No

85. Note: If you claim Veteran’s Preference, attach a copy of discharge or separation papers (DD214).

86. Uploads

90. Employment Record
    List your previous four employers, starting with the most recent one first.

    List your previous four employers, starting with the most recent one first.

92. May we contact your past Employers?

    1. Yes

    1. No

93. May we contact your present Employer?

    1. Yes

    1. No

95. Company Name

96. Position/Title

98. Address

100. City

101. State

102. Zip Code

104. Start
     Start

105. End
     End

106. Wage/Salary

107. Telephone

109. Supervisor

110. Reason for Leaving

112. Major Duties

116. Company Name

117. Position/Title

119. Address

121. City

122. State

123. Zip Code

125. Start
     Start

126. End
     End

127. Wage/Salary

128. Telephone

130. Supervisor

131. Reason for Leaving

133. Major Duties

137. Company Name

138. Position/Title

140. Address

142. City

143. State

144. Zip Code

146. Start
     Start

147. End
     End

148. Wage/Salary

149. Telephone

151. Supervisor

152. Reason for Leaving

154. Major Duties

156. Professional References
     Provide the names and requested information for three persons not related to you, who have known you for at least one year who would know your qualifications and/or character.

     Provide the names and requested information for three persons not related to you, who have known you for at least one year who would know your qualifications and/or character.

158. First Name

159. Last Name

161. Address

163. City

164. State

165. Zip Code

167. Phone Number

168. Relationship

169. Years Acquainted

173. First Name

174. Last Name

176. Address

178. City

179. State

180. Zip Code

182. Phone Number

183. Relationship

184. Years Acquainted

188. First Name

189. Last Name

191. Address

193. City

194. State

195. Zip Code

197. Phone Number

198. Relationship

199. Years Acquainted

201. Have you ever plead no contest, plead guilty, or been found guilty of a misdemeanor or felony offense?

     1. Yes

     1. No

203. Provide dates and nature of offense(s), place of occurrence, and the name and address of the police department or court involved. A criminal record will not necessarily disqualify an applicant from employment.

205. Has your driver’s license ever been suspended?

     1. Yes

     1. No

207. For what reason?

211. Applicant’s Pre-Employment Agreement
     Applicant: Please read carefully before signing this application.<br><br> I understand that submission of an application does not guarantee employment. I further understand that employment obtained with Muhlenberg Township is employment at will unless otherwise stated in a collective bargaining agreement, for no specified duration and may be terminated either by the Township or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of Muhlenberg Township representatives used during the employment process is deemed a contract of employment real or implied.<br><br> In consideration for employment with Muhlenberg Township; if employed, I agree to conform to the rules, regulations, policies and procedures. I understand that if offered a position, I may be required to submit to a pre-employment medical examination, drug screening and background checks as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment checks will result in my withdrawal of any employment offer or termination of employment if already employed.<br><br> I understand that I will be required to provide documentation of identity and employment eligibility prior to starting employment as required by the Immigration Reform and Control Act of 1986.<br><br> I certify that, to the best of my knowledge and belief, all of the information on and attached to this application is true, correct, complete and made in good faith. I understand that false or fraudulent information on or attached to this application may be grounds for not hiring me or for firing me after I begin work, and may also be punishable by law. I understand that any information I give may be investigated and I release all parties involved from any and all liability for any and all damage that may result from providing such information.<br><br> By signing, I acknowledge that I understand and agree to the above statements.

     Applicant: Please read carefully before signing this application.
     
     I understand that submission of an application does not guarantee employment. I further understand that employment obtained with Muhlenberg Township is employment at will unless otherwise stated in a collective bargaining agreement, for no specified duration and may be terminated either by the Township or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of Muhlenberg Township representatives used during the employment process is deemed a contract of employment real or implied.
     
     In consideration for employment with Muhlenberg Township; if employed, I agree to conform to the rules, regulations, policies and procedures. I understand that if offered a position, I may be required to submit to a pre-employment medical examination, drug screening and background checks as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment checks will result in my withdrawal of any employment offer or termination of employment if already employed.
     
     I understand that I will be required to provide documentation of identity and employment eligibility prior to starting employment as required by the Immigration Reform and Control Act of 1986.
     
     I certify that, to the best of my knowledge and belief, all of the information on and attached to this application is true, correct, complete and made in good faith. I understand that false or fraudulent information on or attached to this application may be grounds for not hiring me or for firing me after I begin work, and may also be punishable by law. I understand that any information I give may be investigated and I release all parties involved from any and all liability for any and all damage that may result from providing such information.
     
     By signing, I acknowledge that I understand and agree to the above statements.

213. Signature of Applicant

214. Date of Signing
     Date of Signing

216. Muhlenberg Township is an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, gender, age, marital status, veteran eligibility, disability, national origin, or any other legally protected status. No question on this application is asked for the purpose of disclosing any applicant’s legally protected status. Applicants requiring accommodation in the application or hiring process should contact the Human Resources Administrator.

     Muhlenberg Township is an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, gender, age, marital status, veteran eligibility, disability, national origin, or any other legally protected status. No question on this application is asked for the purpose of disclosing any applicant’s legally protected status. Applicants requiring accommodation in the application or hiring process should contact the Human Resources Administrator.

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217. 1. Receive an email copy of this form.
218. Email address

     This field is not part of the form submission.

219. Submit Submit and Print

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