Employment Application

MUNICIPALITY OF PENN HILLS
12245 FRANKSTOWN ROAD
PENN HILLS , PA 15235
(412)798-2100
Fax: (412) 798-2109

Applicant Info

Position Desired (required)

Last Name (required)

First Name (required)

MI

Address (required)

City (required)

State (required)

Zip Code (required)

Email (required)

Telephone (H) (required)

Telephone (W)

If your application is considered favorably, on what date will you be available for employment?

Would you accept:
 Temporary Employment Part-time Employment

Were you previously employed by the Municipality?
 No Yes

If yes, when and in what capacity?

Were you ever convicted of a felony or misdemeanor?
 No Yes

If yes, please explain details, dates, etc.

The Immigration and Control Act of 1986 requires all persons hired for employment to submit documents which establish their identity and work authorization.

Are you legally eligible to work in the U.S.?
 No Yes

Educational Background

High School

Name and Location

Courses Taken

Graduated
 No Yes Enrolled

College or University

Name and Location

Courses Taken

Graduated
 No Yes Enrolled

Business, Trade or Technical

Name and Location

Courses Taken

Graduated
 No Yes Enrolled

Other

Name and Location

Courses Taken

Graduated
 No Yes Enrolled

Driver’s License number and state

List any additional training, skills or equipment you are skilled in operating, relating to the position for which you are applying. (This may include computer skills, typing speed, CDL license, or any other skills.)

Employment Record

Begin with your most recent job. List all jobs and periods of unemployment in the last ten years. Also list jobs beyond ten years if the experience helps to qualify you for the position. Include paid or unpaid, full or part-time, military, summer jobs, etc. This section must be fully completed. A resume may be attached, but may not be substituted for completion of this section.

May we contact your present employer?

Company

Name

Address

From

To

Description of Duties

Type of Business

Salary

Phone

Supervisors Name

Reason for Leaving


Company

Name

Address

From

To

Description of Duties

Type of Business

Salary

Phone

Supervisors Name

Reason for Leaving


Company

Name

Address

From

To

Description of Duties

Type of Business

Salary

Phone

Supervisors Name

Reason for Leaving


Company

Name

Address

From

To

Description of Duties

Type of Business

Salary

Phone

Supervisors Name

Reason for Leaving

Personal References

(Not former employers or relatives)

Name

Company and Title

Phone Number


Name

Company and Title

Phone Number


Name

Company and Title

Phone Number

I declare that the facts set forth in this application are true and complete. I understand that false or misleading statements made by me on this application and any attachments shall cause me to be ineligible for employment or considered sufficient cause for dismissal. I also understand that a post-offer, pre-employment physical examination is required, which may include a drug screening urinalysis, and employment is conditional upon successfully passing the examination. All medical information will be classified as confidential. I authorize the Municipality of Penn Hills to verify the accuracy of the information on this application and any attachments. I further authorize the Municipality of Penn Hills to obtain information regarding my work history from previous employers, references, education and training, and criminal history, including driving record.

Signature of Applicant (required)

Date of Application (required)