CENTRAL BLAIR RECREATION & PARK COMMISSION
Personal Information
APPLICATION FOR
EMPLOYMENT DATE
This Commission is an equal opportunity
employer. Federal and State laws
prohibit discrimination in employment because of race, color, religion, age,
sex, or national origin. No question on
this application is asked for the purpose of limiting or excluding any applicant’s
consideration for employment because of his or her race, color, religion, age,
sex, or national origin.
Name Social
Security No.
(Last) (First) (Middle initial)
Present
Address
(No.
Street) (city) (state) (zip)
Telephone
Number ( ) Cell
Number (_____) Sex
Male Female
Have you
lived at this address more than one year? If
not, please state previous address:
(No.
Street) (City) (State) (Zip)
Are you 16
years of age or older?
Are you more
than 65 years of age?
Position(s)
applied for:
Full Time Part Time Summer
Were you
previously employed by us? Position
Have you ever
pleaded guilty or been convicted of a crime other than a misdemeanor or summary
offense? Yes ________ No__________
Do you have a
current/valid PA driver’s license?
If your
application is considered favorably, on what date will you be available for
work? 20
Education
High
School: Grade completed as of June 15,
2009 9th 10th 11th 12th
School City
High School
Diploma: Yes No G.E.D.:
Yes No
College: Number of years completed 1 2 3 4
School City State
Major Degree Earned
Certificates
and/or background information for job applied.
OVER
Employment
- List last employer first. Include
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Date Month
and Year |
Name
and Address of Employer |
Salary |
Position |
Reason
for Leaving |
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From
______________ To____________ |
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From ______________ To____________ |
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From _____________ To
_____________ |
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From
_____________ To
_____________ |
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References - Give below the names of three persons not related to you, whom you have
known at least 1 year.
|
Name |
Address |
Business |
Phone
Number |
|
1. |
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2. |
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3. |
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Physical Record
Do
you possess any physical disabilities which would prevent you from performing
the position sought? Yes No
Give
details -
In
case of emergency notify
(Name) (Address) (Phone number)
I hereby certify
that the foregoing statements are true and correct to the best of my knowledge
and belief, and hereby grant the Commission permission to verify such
answers. I understand that any false
statement on this application may be considered as sufficient cause for
rejection of this application or for dismissal if such false statement is
discovered subsequent to my employment.
I understand that as a part of the Commission procedure for processing
my employment application, an investigation and a report may be made by a
consumer reporting agency in the process of which information may be obtained
through interviews with third parties, such as family members, business
associates, financial sources, friends, neighbors, or others with whom the
applicant has been acquainted. This
inquiry may include information as to the applicant’s character, general
reputation, personal characteristics, whichever may be applicable. I understand that under the Federal Fair Credit
Reporting Act, I have the right to make a written request within a reasonable
period of time for a complete and accurate disclosure by the Commission of the
nature and scope of the investigation requested. If this application for
employment is denied either wholly or partly because of information contained
in a consumer report from a consumer reporting agency making the report.
Signature