Employment Application THE BOROUGH OF WILKINSBURG IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL BE CONSIDERED WITHOUT REGARD TO RACE, COLOR, RELIGION, NATIONAL ORIGIN, AGE, SEX, SEXUAL ORIENTATION, GENDER IDENTITY, DISABILITY, OR PREGNANCY. ALL INFORMATION REQUESTED ON THIS APPLICATION FORM IS SOLICITED FOR THE PURPOSE OF DETERMINING ABILITIES AND SKILLS REQUIRED FOR PROPER JOB PLACEMENT AND TO FACILITATE VERIFICATION OF THE INFORMATION REQUESTED. (This application is NOT for Police Officer candidates) Position Applying For:*Seeking:* Full Time Part Time Seasonal How did you hear about the position?Name* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Best number to reach you during business hours.Email Address Public Works, Code Enforcement, Parking Enforcement Only - Driver's License Number:Public Works, Code Enforcement, Parking Enforcement Only - Driver's License State:N/AAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificAre you at least 18 years old?*YesNoIf no, do you have a work permit?YesNoN/AAre you a United States Citizen or authorized to work in the United States?*YesNoSuccessful applicants are required to verify citizenship or authorization to work in the United States, as well as to provide documentation of identity and employment eligibility prior to starting employment as required by law.Have you ever applied for a job with the Borough of Wilkinsburg?*NoYesIf yes, when did you last apply?Have you ever been employed by the Borough of Wilkinsburg?*NoYesIf yes, when were you employed here?May we contact your current employer?*YesNoIf no, please identify someone familiar with your performance with your current employer that we may contact below.Supervisor Name & Number*Can you work:* Daylight Evenings Nights Weekends EducationDo you have a High School Diploma or G.E.D. Certificate?*YesNoName of last High School attended.*Colleges, Universities, Trade or Technical Schools or Apprenticeship Programs attended:NameLocationNumber of Years/Months AttendedDegrees, Credits, Certificates or Licenses Add additional schools by clicking the "+" button.MilitaryBranch of ServiceLength of ServiceRank at SeparationSpecialized Training:Are you seeking a hiring preference under the Veteran's Preference Act?YesNoIf yes, attach a copy of discharge or separation papers, DD Form 214, if any.Skills/QualificationsDescribe the type of equipment you are capable of operating (machines, vehicles, computers, etc.)List any relevant certificates or licenses you hold:Summarize special skills, abilities or experiences which qualify you for this position.BackgroundHave you ever been convicted of, or pleaded guilty or no contest, to any misdemeanor or felony?*YesNoIf yes, please identify the violations that you were convicted of and provide the date and place of your conviction. Conviction will not necessarily disqualify an applicant from employment.Employment HistoryNOTE: WE RESERVE THE RIGHT TO VERIFY ANY EMPLOYMENT HISTORY OR RECORDS. List previous employment here, beginning with current or most recent position. If you have more employment to list, be sure to attach a resume before submitting.Employment InformationEmployerDates Employed (from - to)Job TitleAddressSupervisor's Name & Number Brief Description of Job Duties and Reason for leaving:Will this supervisor/employer give a good job reference?YesNoIf no, explain:Were you discharged or asked to leave by this employer?YesNoWere you ever suspended or given a written warning by this employer?YesNoEmployment InformationEmployerDates Employed (from - to)Job TitleAddressSupervisor's Name & Number Brief Description of Job Duties and Reason for leaving:Will this supervisor/employer give a good job reference?YesNoIf no, explain:Were you discharged or asked to leave by this employer?YesNoWere you ever suspended or given a written warning by this employer?YesNoEmployment InformationEmployerDates Employed (from - to)Job TitleAddressSupervisor's Name & Number Brief Description of Job Duties and Reason for leaving:Will this supervisor/employer give a good job reference?YesNoIf no, explain:Were you discharged or asked to leave by this employer?YesNoWere you ever suspended or given a written warning by this employer?YesNoReferencesPlease list 3 references other than relatives or former employers:ReferencesNameAddressPhone NumberRelationship Click the "+" sign to add additional references.File Upload Drop files here or Upload resume, cover letter, and any other relevant documentation.Certification, Authorization, and AgreementI certify that the information supplied by me on this application form and in my resume, if any, is true and complete and does not contain any falsifications, omissions, or concealments of material fact. I authorize the Borough of Wilkinsburg to investigate the truth of this information and of any other information I may supply during a pre-employment interview. I further authorize every school, employer, person and agency identified by me on this form or in my resume to release any and all verifying information the Borough of Wilkinsburg may solicit from it or them. I further authorize the Borough of Wilkinsburg to investigate my criminal history and other aspects of my personal history, including my character and general reputation. If my application is denied in whole or in part because of information contained in criminal history records, the Borough of Wilkinsburg will so advise me. I hereby release all law enforcement agencies, my former employers, all educational institutions and programs and every other person identified by me on this form or in my resume from liability for any damage or injury to me arising out of the release of information requested by the Borough of Wilkinsburg. I understand and agree that the Borough of Wilkinsburg's acceptance of this application does not constitute any promise, expressed or implied, that I will be hired. I further understand that the Borough of Wilkinsburg does not guarantee anyone employment for any specific length of time. I therefore agree that, if I am hired, my employment may be terminated by either me or by the Borough of Wilkinsburg at any time with or without cause and without prior notice, except as may be required by law. I further understand and agree that any offer of employment the Borough of Wilkinsburg may make me (and, if I am hired, my continued employment) will be contingent upon my submission of evidence verifying that I am authorized to work in the United States and may be contingent upon my taking and passing physical examinations and drug tests. I certify that I am not a party to any contract or other obligation which would limit, interfere with or restrict my ability to work for the Borough of Wilkinsburg in any way. I hereby acknowledge that I have read this section of the employment application and fully understand the meaning and effect of signing this form.Signed:*You agree that typing your full name here will be the equivalent of signing a physical signature.