Application for Employment


Application for Employment

Personal Information

Address *

Employment Eligibility

If you are under 18 and it is required, can you furnish a work permit? *
Have you submitted an application here before? *
Have you ever been employed here before? *
Is this application a request for reemployment following an extended military leave of absence from this company? *
Are you lawfully authorized to work in the United States? *

Employment Preferences

Type of employment desired *
Will you travel if job requires it? *
If they have been explained to you, are you able to meet the attendance requirements of the position? *
Will you work overtime if required? *

Reasonable Accommodation

Are you able to perform the “essential functions” of the job for which you are applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.
Reasonable Accommodations *

Employment History

Starting with your most recent employer, please list your employment history for the last 10 years.


May we contact for reference? *

Skills and Qualifications

Computer Skills (include software titles and level of experience, such as basic, intermediate, or advanced.)

Educational Background



Reference Names

Please list three professional references.

Related Information

When answering these questions, please exclude any information that would reveal race, color, religion, sex (including pregnancy), military status, national origin, disability, age, ancestry, genetic information, or other similarly protected status.

Applicant Statement and Signature

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete, and correct.

I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, résumé, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law.

I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment. My personal information may be shared with the employer’s affiliate(s) and third parties engaged by the employer to perform services for the employer. Any personal information shared with an affiliate or third party is to be used solely to perform the services requested by the employer.

Mifflin Township does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her race, color, religion, sex (including pregnancy), military status, national origin, disability, age, ancestry, genetic information, or any other protected status under applicable federal, state, or local law.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.

Cover Letter/Resume Upload

Maximum file size: 8MB