16161 Dunnings Highway, Newry, PA • 814-695-6062

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Employment Application

Name

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Home Phone Number(Required)

Cell Phone Number

Email

Address(Required)

Street Address Address Line 2 City State ZIP Code

Position Desired:(Required)

Have you been an employee of this organization in the past?

Yes

No

I have a valid drivers license:

Yes

No

License number:

State issued:

I have a clean driving record:

Yes

No

I certify that I am a U.S. Citizen, permanent resident, or a foreign national with authorization to work in the United States:

Yes

No

Have you ever been convicted of, or entered a plea bargain of guilty, no contest, or had a witheld judgement to a felony?

Yes

No

If yes, please explain:

Education

School name and location:

Dates attended:

Did you graduate?

Degree Achieved:

School name and location:

Dates attended:

Did you graduate?

Degree Achieved:

School name and location:

Dates attended:

Did you graduate?

Degree Achieved:

REFERENCES

Name:

Position:

Phone Number:

Name:

Position:

Phone Number:

Name:

Position:

Phone Number:

PREVIOUS EMPLOYMENT

Date started

Date ended

Position

Start and End Salary

Job responsibilities:

Employer name/address/contact info:

Reason for leaving:

May we contact this employer?

Yes

No

Date Started

Date Ended

Position

Start and End Salary

Job responsibilities:

Employer name/address/contact info:

Reason for leaving:

May we contact this employer?

Yes

No

Date Started

Date Ended

Position

Start and End Salary

Job responsibilities:

Employer name/address/contact info:

Reason for leaving:

May we contact this employer?

Yes

No

I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that, if I am employed, false statements on this application shall be considered suffcient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history.

Signature

Your Name
Your Name
Your Name

Date(Required)

Δ

			      	
								© 2026. All Rights Reserved • Privacy Policy
							
							16161 Dunnings Highway

							Newry, PA  16665
						
							814-695-6062
						
							Mon - Fri: 8:30 a.m. - 5 p.m.

							Sat: 9 a.m. - 1 p.m.

							Evenings by appointment.

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