Washington County PA: Official Website

Employment Application

Notice

All fields are required. Please use N/A if a question doesn't apply.

Choose position applying for:

Name

Home Street Address

City

State

Zip Code

Email address

Are you a Washington County resident?

Have you previously been employed by us?

Home Phone

Cell Phone

Work Type

Date Available

How did you hear about us?

Have you ever been convicted of a felony?

If yes, please explain.

Are you willing to travel?

PA License No.

Computer Programs

Other Skills

Typing WPM

Civic Activities

Have you served in the military?

If yes, which branch?

Education

High School Name and Address

High School Years Completed

High School Degree

College Name and Address

College Years Completed

College Degree

Trade School Name and Address

Trade School Years Completed

Trade School Degree

Other School Name and Address

Other School Years Completed

Other School Degree

Last Three Employers

Employer 1 Name and Address

Start Date

End Date

Employer 1 Phone

Employer 1 Position

Employer 1 Responsibilities

Employer 1 Salary

Employer 1 Supervisor

Employer 1 Reason For Leaving

Employer 2 Name and Address

Start Date

End Date

Employer 2 Phone

Employer 2 Position

Employer 2 Responsibilities

Employer 2 Salary

Employer 2 Supervisor

Employer 2 Reason For Leaving

Employer 3 Name and Address

Start Date

End Date

Employer 3 Phone

Employer 3 Position

Employer 3 Responsibilities

Employer 3 Salary

Employer 3 Supervisor

Employer 3 Reason For Leaving

References (Not A Previous Employer/Relation)

Reference 1 Name and Address

Reference 1 Email

Reference 1 Phone

Reference 2 Name and Address

Reference 2 Email

Reference 2 Phone

Reference 3 Name and Address

Reference 3 Email

Reference 3 Phone

Signature

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

Signature

Date