Application (Administrative)

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Employment Application (Administrative)

Area Transportation Authority of North Central Pennsylvania an Equal Opportunity Employer (M/F) 44 Transportation Center, Johnsonburg, PA 15845-2102

Please complete this application with as much information as possible. Our Human Resources Representative will contact you for additional information if needed.

[click here] to download the PDF and print the application.

Email(*)

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Position Applied for:(*)

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Date of Application:(*)

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Name: (Last, First, Middle)(*)

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Address:(*)

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City:(*)

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County:(*)

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State:(*)

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Zip:(*)

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Telephone:(*)

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Do you hold a valid Pennsylvania Driver’s License?(*)

YESNO Invalid Input

Date of Birth:(*)

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Are you a U.S. Citizen?(*)

YESNO Invalid Input

Have you worked for this Company before?(*)

YESNO Invalid Input

If so, where

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Does this agency currently employ any member of your immediate family?(*)

YESNO Invalid Input

Names of relatives in our employ

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Does any member of your immediate family currently serve on the Board of Directors of this Authority?

YESNO Invalid Input

Name(s) of relatives on the Board

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MILITARY STATUS

Have you served in the U.S. Armed Forces?

YESNO Invalid Input

Branch

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Date joined:

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Rank at Discharge

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Date of Discharge:

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Type of Discharge

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Draft Status

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Reserve Status

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EDUCATIONAL RECORD

High School Name and Location:

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High School Semester Credits:

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High School Diploma/Degree Awarded:

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High School Major Subject/Coursework:

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College or University Name and Location:

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College or University Semester Credits:

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College or University Diploma/Degree Awarded:

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College or University Major Subject/Coursework:

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Graduate or Professional Name and Location:

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Graduate or Professional Semester Credits:

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Graduate or Professional Diploma/Degree Awarded:

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Graduate or Professional Major Subject/Coursework:

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Other Schooling (e.g. training) Specify Name and Location:

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Other Schooling (e.g. training) Specify Semester Credits:

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Other Schooling (e.g. training) Specify Diploma/Degree Awarded:

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Other Schooling (e.g. training) Specify Major Subject/Coursework:

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EMPLOYMENT

List your complete employment record. Include periods of unemployment, starting with your present or last position and work back.

Job #1 Information

Dates Employed: (From [MM/DD/YYYY] - To [MM/DD/YYYY])

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Name and Address of Company:

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Position Held:

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Starting Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Ending Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Immediate Supervisor Name & Phone Number:

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Number of Hours Worked each week:

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Number of Employees supervised:

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Fully describe your major duties and responsibilities:

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Reason for leaving:

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Job #2 Information

Dates Employed: (From [MM/DD/YYYY] - To [MM/DD/YYYY])

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Name and Address of Company:

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Position Held:

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Starting Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Ending Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Immediate Supervisor Name & Phone Number:

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Number of Hours Worked each week:

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Number of Employees supervised:

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Fully describe your major duties and responsibilities:

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Reason for leaving:

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Job #3 Information

Dates Employed: (From [MM/DD/YYYY] - To [MM/DD/YYYY])

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Name and Address of Company:

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Position Held:

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Starting Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Ending Salary: (Include amount and for what period of time. IE: weekly, annually, etc.)

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Immediate Supervisor Name & Phone Number:

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Number of Hours Worked each week:

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Number of Employees supervised:

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Fully describe your major duties and responsibilities:

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Reason for leaving:

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List any office equipment/hardware that you can operate:

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List software that you have used in your previous work experience: Include Software NAME, TYPE and DEGREE OF PROFICIENCY

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Have you ever been convicted of a misdemeanor or felony (excluding minor traffic violations)?

YESNO Invalid Input

If yes, explain (Include Location, Date, Charge and Penalty for each)

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REFERENCES

PLEASE LIST 3.

List names, address and telephone numbers of three personal references. Do not include relatives:

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A false or dishonest answer to any question on this application will be grounds for rating you ineligible for employment. All statements on this application are subject to investigation including a police check, motor vehicle records check, checks of salaries, references, and former employers. All data will be considered in determining your eligibility for employment with this Authority.

CHECK THE BOX if You acknowledge the above statement and You certify that the statements contained herein are accurate and true to the best of your knowledge, information, and belief.

I AGREE Invalid Input

(*)

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