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Industries
About
- Values & Vision
- History
Careers
Shop
Contact
Client Login
Staff Login

CAREERS

Employment Application

Programs, services, and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview.

Full Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Cell/Beeper/Other Phone(Required)

E-Mail Addreess(Required)

Date available to start(Required)

MM slash DD slash YYYY

If you are under 18 and we require a work permit, can you furnish one?(Required)

Yes

No

Please Explain(Required)

Have you ever worked for this company?(Required)

Yes

No

When?(Required)

Are you a citizen of the United States?(Required)

Yes

No

are you legally allowed to work In the United States?(Required)

Yes

No

Type of employment desired(Required)

Full Time

Part Time

Temporary

Seasonal

Have you ever pled “guilty,” “no contest,” or been convicted of a crime?(Required)

Yes

No

Give dates and details(Required)

Answering "yes" to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be considered.

Driver's license number if applicable to position(Required)

State(Required)

Who referred you to us?(Required)

EDUCATION

High School(Required)

Address(Required)

# of Years Completed

Did you graduate?

Yes

No

GPA(Required)

Class Rank(Required)

College/University

Address

# of Years Completed

Did you graduate?

Yes

No

Degree

Major

GPA

Class Rank

Other

Address

# of Years Completed

Did you graduate?

Yes

No

Degree

Major

GPA

Class Rank

REFERENCES

Please furnish the names, addresses and telephone numbers of two people to whom you are not related and by whom you have not been employed.

Name(Required)

Phone(Required)

Address(Required)

Street Address City State ZIP Code

Name

Phone

Address

Street Address City State ZIP Code

SUMMARIZE YOUR SPECIAL SKILLS OR QUALIFICATIONS

SUMMARIZE YOUR SPECIAL SKILLS OR QUALIFICATIONS(Required)

PREVIOUS EMPLOYMENT (begin with most recent position)

Dates of Employment From(Required)

MM slash DD slash YYYY

Dates of Employment To(Required)

MM slash DD slash YYYY

Position(s) Held(Required)

Firm(Required)

Address(Required)

Phone(Required)

Supervisor(Required)

Title(Required)

Responsibilities(Required)

Reason for Leaving(Required)

May we contact this employer for a reference?(Required)

Yes

No

Dates of Employment From(Required)

MM slash DD slash YYYY

Dates of Employment To(Required)

MM slash DD slash YYYY

Position(s) Held(Required)

Firm(Required)

Address(Required)

Phone(Required)

Supervisor(Required)

Title(Required)

Responsibilities(Required)

Reason for Leaving(Required)

May we contact this employer for a reference?(Required)

Yes

No

Dates of Employment From(Required)

MM slash DD slash YYYY

Dates of Employment To(Required)

MM slash DD slash YYYY

Position(s) Held(Required)

Firm(Required)

Address(Required)

Phone(Required)

Supervisor(Required)

Title(Required)

Responsibilities(Required)

Reason for Leaving(Required)

May we contact this employer for a reference?(Required)

Yes

No

Consent(Required)

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. 1 hereby release employers, schools or persons from all liability when responding to inquiries in connection with my application.(Required)

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

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(717) 264-3700

Office Location
900 Kriner Rd,
Chambersburg, PA 17202

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