Job Application

We are an Equal Opportunity Employer.

PERSONAL INFORMATION:
Social Security Number:
Name (First, Middle, Last):
Street:
City:
State:     Zip:   
Daytime Phone:
Evening Phone:
Email:
Are you a United States Citizen Yes No*
*If you answered No are you authorized to work in the United States? Yes No
Are you 18 years of age or older? Yes No
Have you ever been arrested and convicted of a felony? Yes No
ANSWER ALL QUESTIONS OR YOU WILL NOT BE CONSIDERED FOR EMPLOYMENT
EMPLOYMENT DESIRED:
Position for which you are applying:
Are you available for flexible hours? 7 days a week? Yes No*
*If you answered No, please explain:
Is there any reason that we would not be able to insure you for handling money? Yes No
*If you answered Yes, please explain:
Wage/Salary Expected:
How did you find out about us?
Have you ever been employed by the Parking Authority? Yes* No
*If yes, when?:
Have you ever applied to the Parking Authority? Yes* No
*If you answered Yes, when did you previously apply?:
Do you have any physical or medical conditions that require any special accommodations? Yes* No
*If yes, please specify?:
EDUCATION:
High School:
Name of School
Location of School
# of Years Attended
Did you Graduate Yes   No
Subjects Studied
College
Name of School
Location of School
# of Years Attended
Did you Graduate Yes   No
Subjects Studied
Trade, Business, Correspondence School
Name of School
Location of School
# of Years Attended
Did you Graduate Yes   No
Subjects Studied
Other Adult Education
Name of School
Location of School
# of Years Attended
Did you Graduate Yes   No
Subjects Studied

MILITARY SERVICE:
Have you ever been a member of the U.S. Military or Naval Service?
Yes*   No
*If you answered Yes, what rank did you hold?
Did you receive an honorable discharge?
Yes   No
Are you presently a member of the National Guard or Reserves?
Yes   No

GENERAL INFORMATION:
List any subjects of special study or research work:

List any special skills that you have that would assist in performing the duties of the position for which you are applying:

List any activities, hobbies, or organizations to which you belong"
(Please exclude organizations of which the name indicates the race, creed, sex, age, marital status, color, or nation of origin of its members)

EMPLOYMENT HISTORY:
Please List your last 3 employers, starting with the most recent:
Most Recent Employer
Name of Employer:
Location:
Dates of Employment: From to
Salary/Wage:
Position:
Reason for Leaving:
Previous Employer
Name of Employer:
Location:
Dates of Employment: From to
Salary/Wage:
Position:
Reason for Leaving:
Previous Employer
Name of Employer:
Location:
Dates of Employment: From to
Salary/Wage:
Position:
Reason for Leaving:
References
Please give the names of three individuals whom you have known for at least one (1) year. NO relatives please.
1.
2.
3.

CERTIFICATION AND SIGNATURE:
"I certify that 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."

"I authorize investigation of all statements contained herein, the references listed above as well as a criminal back ground check to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you. I further understand my employment is contingent upon the above mentioned investigation results."

"I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause."

Name/Signature:   Date:2/5/2012

111 North Prince Street, P.O. Box 866, Lancaster, PA 17608-0866
Phone: 717.299.0907 :: Fax: 717.291.7296 :: Email Us
© 2012, Lancaster Parking Authority. All Rights Reserved.