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Application for employment

BRADFORD COUNTY COURT HOUSE

301 Main Street

Towanda, PA 18848

(570) 265-1722

Present Address
Were you previously employed by Bradford County?
If yes, when?


Are you over the age of eighteen (18)?
If NO, hire is subject or verification that you are a minimum legal age.


If hired, can you give written evidence of your right to work in the United
States?
Reason(s) for interest in position(s) applied:
Would you work

Shift preferred:


Available Weekends?
Available for Shift Work?
If your application is considered favorably, on what date will you be available
for work?

EDUCATION

Did you Complete?

MILITARY SERVICE

Were you in the U.S. Armed Forces?
If yes, what branch?


Dates of Duty:
Rank and Discharge:
Type of Discharge:
List duties in the service including special training:
Since the age of eighteen (18) have you ever been convicted of a misdemeanor or
felony?
If yes, please explain:

(Note: A conviction will not necessarily bar you from employment. Each
conviction will be judged on its own merits.)

EMPLOYMENT HISTORY
LIST BELOW ALL PRESENT AND PAST EMPLOYMENT BEGINNING WITH THE MOST RECENT

1
Job Title & describe work performed:
Employed
Reason for Leaving


2
Job Title & describe work performed:
Employed
Reason for Leaving


3
Job Title & describe work performed:
Employed
Reason for Leaving


Summarize and Special Skill and Qualifications acquired from employment or other
experience:
May we contact the employers listed above?
If NO, indicate by number which one(s) you do not wish us to contact:


Reason(s):
Have you ever been disciplined or fired?
If YES, why?

PROFESSIONAL REFERENCES


It is the policy of the Bradford County Commissioners to consider all applicants for
employment without regard to age, race, color, national origin, sex, ancestry,
religion, or disability; also, affirmative action will be taken to employ and
advance in employment qualified handicapped individuals who, with reasonable
accommodation, can perform the functions of a job.

EQUAL OPPORTUNITY EMPLOYER.


INFORMATION RELEASE FORM

I authorize employment information to be released to the Bradford County Human Resources Office. I further understand that all information will be held in strict confidence, and I hereby release both Bradford County and the previous employer (s), school (academic records), and/or personal references from any liability for damages resulting directly or indirectly from such disclosures.



It is the policy of the Bradford County Commissioners to consider all applicants for employment without regard to age, race, color, national origin, sex, ancestry, religion, or disability; also, affirmative action will be taken to employ and advance in employment qualified handicapped individuals who, with reasonable accommodation, can perform the functions of a job.

EQUAL OPPORTUNITY EMPLOYER.