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2. THIS APPLICATION IS NOT FOR POLICE POSITIONS
4. 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.

6. First Name
7. Middle Name
8. Last Name
10. Address*
12. City*
13. State*
14. Zip Code*
16. Temporary Address
18. City
19. State
20. Zip Code
22. Cell Phone*
23. Evening Phone
24. Email Address*
26. Are you 18 years of age or older?

    1. Yes

    1. No
27. Do you have relatives currently working for Muhlenberg Township?

    1. Yes

    1. No
29. If Younger Than 18, List Birth Date
    If Younger Than 18, List Birth Date
30. List Department
32. Employment Desired

    1. Full Time
    2. Part Time
    3. Seasonal
33. Position Applied For
35. Can you perform the essential functions of the position that you are applying for?

    1. Yes

    1. No
36. Date You Are Available
    Date You Are Available
38. Are you employed now?

    1. Yes
    2. No
39. Do you object to working overtime?

    1. Yes
    2. No
40. Can you work overtime without prior notice?

    1. Yes
    2. No
44. Education & Training History
46. High School Address
48. City
49. State
50. Zip Code
52. Year Diploma or GED Was Received
    Graduation year is used for verification purposes only.
53. Mark the Highest Level of Education Completed

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

    1. Bachelor
    2. Master
    3. Doctoral
55. College/University Attended
56. Major Course of Study
57. Degree (if Any) and Year Received
59. College/University Attended
60. Major Course of Study
61. Degree (if Any) and Year Received
63. College/University Attended
64. Major Course of Study
65. Degree (if Any) and Year Received
67. Other Education Completed/Certifications, Licenses, Etc.
    The information provided should directly relate to the duties of the position for which you are applying.
69. Do you have a valid driver’s license?

    1. Yes

    1. No
70. Do you have a valid Commercial Driver’s License?

    1. Yes

    1. No
72. State & Expiration Date
76. Have you served in the U. S Armed Forces, including the U.S. Reserve or State Guard?

    1. Yes

    1. No
78. Branch
79. Date Entered
    Date Entered
80. Date Discharged
    Date Discharged
82. Highest Rank
83. Nature of Duties & Responsibilities
85. Do you claim Veteran’s Preference?

    1. Yes

    1. No
87. Note: If you claim Veteran’s Preference, attach a copy of discharge or separation papers (DD214).
89. Uploads Supporting Documents (Cover Letters, Resume, Etc.)
93. Employment Record
    List your previous four employers, starting with the most recent one first.
95. May we contact your past Employers?

    1. Yes

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

    1. Yes

    1. No
98. Company Name
99. Position/Title
101. Address
103. City
104. State
105. Zip Code
107. Start
     Start
108. End
     End
109. Wage/Salary
110. Telephone
112. Supervisor
113. Reason for Leaving
115. Major Duties
119. Company Name
120. Position/Title
122. Address
124. City
125. State
126. Zip Code
128. Start
     Start
129. End
     End
130. Wage/Salary
131. Telephone
133. Supervisor
134. Reason for Leaving
136. Major Duties
140. Company Name
141. Position/Title
143. Address
145. City
146. State
147. Zip Code
149. Start
     Start
150. End
     End
151. Wage/Salary
152. Telephone
154. Supervisor
155. Reason for Leaving
157. Major Duties
159. 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.
161. First Name
162. Last Name
164. Address
166. City
167. State
168. Zip Code
170. Phone Number
171. Relationship
172. Years Acquainted
176. First Name
177. Last Name
179. Address
181. City
182. State
183. Zip Code
185. Phone Number
186. Relationship
187. Years Acquainted
191. First Name
192. Last Name
194. Address
196. City
197. State
198. Zip Code
200. Phone Number
201. Relationship
202. Years Acquainted
204. Have you ever plead no contest, plead guilty, or been found guilty of a misdemeanor or felony offense?

     1. Yes

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

     1. Yes

     1. No
210. For what reason?
214. 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.
216. Signature of Applicant
217. Date of Signing
     Date of Signing
219. 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.
Leave This Blank:


221. 1. Receive an email copy of this form.
222. Email address

     This field is not part of the form submission.

223. Submit Submit and Print

* indicates a required field