RIDGEBURY TOWNSHIP
APPLICATION FOR EMPLOYMENT
Ridgebury Township                                 Ph: 570 596 2731
13278 Berwick Turnpike, Gillett PA 16925                       fax: 570 596 7731
All applicants will be considered without regard to race, religion, color, sex, national origin, age, maritial or veteran status, medical condition, handicap or disability, sexual orientation, citizenship status or any other status protected by law.      
Date:    
Name:  
Last  /  First  /  Middle Initial
Address:   Telephone:  
 
 
Position(s) applied for or type of work desired:    
Do you have a valid Driver's License?   Yes   No What State:
Do you have a CDL?   Yes   No What State:        
Are you of legal age to work?:   Yes   No
Are you currently employed?   Yes   No
Date you are available to start work         Salary or wages desired   $        Hr   Wk
If hired, can you provide written evidence that you are authorized to work in the US?:   Yes   No
Have you been convicted of a crime in the past seven years? (Excluding misdemeanors and traffic offenses.)
(a conviction will not automatically bar employment)   Yes   No
If yes, please explain:                                  
                                 
                                               
EDUCATION
Type Name/Location Course of Study # Years Completed Degree / Diploma
High School                    
 
College                    
 
Technical/Other                    
 
RIDGEBURY TOWNSHIP APPLICATION FOR EMPLOYMENT Page 2 of 2
 
Employment Record- start with most current employment.
Company Name Address Dates Employed Rate of Pay
From To
                                     
                                     
                                     
                                     
                                     
Skills and Qualifications-summarize any job related training, skills, licenses, certifications and/or other qualifications.
                                               
                                               
                                               
                                               
References-Do Not Include Relatives.
Name Occupation Years Known Address/Phone Number
1                                
2                                
3                                
                                               
I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions and references.  I also hereby release from liability the potential employer and its representatives for seeking, gathering and using such information to make employment decisions and all other persons or organizations for providing such information.
I understand that any misrepresentation or material ommission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.
If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment, accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.
I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired.  Failure to submit such proof within the required time shall result in immediate termination of employment.
I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.
Applicant Signature:                       Date:          
Mailing Address: Ridgebury Township 13278 Berwick Turnpike, Gillett PA 16925