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2. Muhlenberg Township Application for Employment

   Muhlenberg Township is an Equal Opportunity Employer. Please Note: Complete all parts of the application - If you have no information to enter in a section, please enter N/A.

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).
87. Uploads Supporting Documents (Cover Letters, Resume, Etc.)
91. Employment Record
    List your previous four employers, starting with the most recent one first.
93. May we contact your past Employers?

    1. Yes

    1. No
94. May we contact your present Employer?

    1. Yes

    1. No
96. Company Name
97. Position/Title
99. Address
101. City
102. State
103. Zip Code
105. Start
     Start
106. End
     End
107. Wage/Salary
108. Telephone
110. Supervisor
111. Reason for Leaving
113. Major Duties
117. Company Name
118. Position/Title
120. Address
122. City
123. State
124. Zip Code
126. Start
     Start
127. End
     End
128. Wage/Salary
129. Telephone
131. Supervisor
132. Reason for Leaving
134. Major Duties
138. Company Name
139. Position/Title
141. Address
143. City
144. State
145. Zip Code
147. Start
     Start
148. End
     End
149. Wage/Salary
150. Telephone
152. Supervisor
153. Reason for Leaving
155. Major Duties
157. 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.
159. First Name
160. Last Name
162. Address
164. City
165. State
166. Zip Code
168. Phone Number
169. Relationship
170. Years Acquainted
174. First Name
175. Last Name
177. Address
179. City
180. State
181. Zip Code
183. Phone Number
184. Relationship
185. Years Acquainted
189. First Name
190. Last Name
192. Address
194. City
195. State
196. Zip Code
198. Phone Number
199. Relationship
200. Years Acquainted
202. Have you ever plead no contest, plead guilty, or been found guilty of a misdemeanor or felony offense?

     1. Yes

     1. No
204. 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.
206. Has your driver’s license ever been suspended?

     1. Yes

     1. No
208. For what reason?
212. Applicant’s Pre-Employment Agreement
     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.
214. Signature of Applicant
215. Date of Signing
     Date of Signing
217. 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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219. 1. Receive an email copy of this form.
220. Email address

     This field is not part of the form submission.

221. Submit Submit and Print

* indicates a required field