Applicant Data
* First Name:
Middle:
* Last Name:
Are you 18 yrs or older?:
--Please select--
Yes
No
* Street address:
* City:
* State/Territory:
--
US-AK
US-AL
US-AR
US-AZ
US-CA
US-CO
US-CT
US-DC
US-DE
US-FL
US-GA
US-HI
US-IA
US-ID
US-IL
US-IN
US-KS
US-KY
US-LA
US-ME
US-MA
US-MD
US-MI
US-MN
US-MO
US-MS
US-MT
US-NC
US-ND
US-NE
US-NH
US-NJ
US-NM
US-NV
US-NY
US-OH
US-OK
US-OR
US-PA
US-RI
US-SD
US-SC
US-TN
US-TX
US-UT
US-VT
US-VA
US-WA
US-WV
US-WI
US-WY
US-OTHER
* ZIP/Postal code:
Country:
--Please select--
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cayman Islands
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Lao Democratic Republic
Latvia
Lebanon
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Malta
Mexico
Micronesia
Moldova
Monaco
Mongolia
Morocco
Mozambique
Myanmar
Namibia
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Lucia
Saint Vincent Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Sierra Leone
Singapore
Slovakia
Slovenia
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vatican
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
* Phone #:
Mobile #:
Your email address will be used as your login name allowing you to return to our website to view your status and update your profile. If you do not have an email address, you can obtain a free account at Yahoo or Hotmail . Please make sure that the syntax of your email address is in the following form: username@ispname.com
* Email:
Please create your password
* Password:
Re-type new password:
* Position Desired:
How I learned of opening:
Date you can start:
* Previous Applicant:
--Please select--
NO
YES
* Previous Employee:
--Please select--
NO
YES
When:
What Campus/Location?:
--Please select--
York
Lancaster
Emigsville
Mechanicsburg
Altoona
Corporate
Dept. & Supervisor:
Reason for leaving?:
Annual salary desired:
Education
Grammar School & Location:
Number of years attended:
--Please select--
1
2
3
4
5
6
7
8
High School & Location:
Number of years attended:
--Please select--
1
2
3
4
5
6
Did you graduate?:
--Please select--
Yes
No
Type of Degree:
--Please select--
Diploma
GED
College & Location:
Number of years attended:
--Please select--
1
2
3
4
5
6
7
8
9
10
Did you graduate?:
--Please select--
Yes
No
Type of Degree:
Associates
Bachelors
Masters
Doctorate
Certification
Diploma
Enrichment Classes
Major and/or Minor:
Trade School & Location:
Number of years attended:
--Please select--
1
2
3
4
Did you graduate?:
--Please select--
Yes
No
Type of Degree:
Certification
Diploma
Associates
Major and/or Minor:
Special Research Work, Training, Skills, or Certifications
Subjects of Special Study:
Special Skills:
Special Training:
Special Certifications:
Criminal History
Have you ever been convicted of a crime? (select yes or no below)
* Criminal History:
--Please select--
NO
YES
* Explanation:
Employment History
* Present/Last Employer (1):
* Job Title 1:
* Starting Date 1:
* Ending Date 1:
* Supervisor & Phone # (1):
* Ok to contact? 2:
--Please select--
Yes
No
* Reason for Leaving? 1:
* Previous Employer (2):
* Job Title 2:
* Starting Date 2:
* Ending Date 2:
* Supervisor & Phone # (2):
* Ok to contact? 1:
--Please select--
Yes
No
* Reason for Leaving? 2:
* Previous Employer (3):
* Job Title 3:
* Starting Date 3:
* Ending Date 3:
* Supervisor & Phone # (3):
* Ok to contact? 3:
--Please select--
Yes
No
* Reason for Leaving? 3:
Work Related References
Please give the names and telephone numbers of three work realted persons you are not related to, whom you have known for at least one year.
* Professional Reference 1:
* Professional Reference 2:
* Professional Reference 3:
Resume & Cover Letter
Your resume can be uploaded in either Microsoft Word or PDF format. You may also paste a plain text version in the text area below. The text area below can also be used for a cover letter and any supplementary information you would like to provide about your career goals, availability, best times to contact you, etc.
*
Add Resume & Attachments
Supported formats: DOC, DOCX, RTF, PDF, TXT, HTML
Cover Letter: Text Resume:
Authorization
By submitting this application, 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 made on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.