Etna Borough Employment Application
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Email *
Date: *
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DD
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YYYY
Full Name (Last, First, Middle Initial) *
Address:  *
Phone Number *
Email Address *
Position Applied For *
Desired Salary
Are You a Citizen of the United Stated? *
If no, are you authorized to work in the United States?
Clear selection
Have You Ever Worked for the Borough of Etna? *
If Yes, when
Have you ever been convicted of a criminal offense involving dishonesty; breach of trust; offenses against children; use, possession, distribution, sale, or manufacture of drugs; violence or threats of violence or use of weapons for which you have not been pardoned or which has not been expunged? NOTE: Criminal convictions are not necessarily a bar to employment; all relevant circumstances will be considered.  *
If Yes, explain:
EDUCATION: Include location, graduation (or anticipated graduation) date, and Diploma/Degree for each school attended. High school, college, vocational school, etc.  *
PREVIOUS EMPLOYMENT: Please list all previous employers over the past ten (10) years; including company name, address, phone number, name of supervisor, job title, starting and ending salary; responsibilities; dates of employment; reason for leaving; and if we may contact them for a reference. 
REFERENCES: Please list three (3) professional references. Including name, company/occupation, phone and email address, and their relationship to you.  *
MILITARY SERVICE: If you served in the military, please list the Branch, dates of service, rank at discharge, and type of discharge. If applicable, please explain if discharge was other than honorable. 
CERTIFICATION, AUTHORIZATION, AND AGREEMENT: I 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 falsification, omissions, or concealment of material fact. I authorize Etna 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 Etna may solicit from them. I further authorize Etna 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 a criminal history report, Etna will so advise me. 

"I hereby release all law enforcement agencies, my former employers, all education insitutions and programs and every other person identified by me on this form or in my resume from liability or any damage or injury to me arise out of the release of information requested by Etna."

"I understand and agree that Etna's acceptance of this employment application does not constitute any promise, express or implied, that I will be hired. I Further understand that Etna does not guarantee anyone employment for an specific length of time. I therefore agree that, if I am hired my employment may be terminated by either me or by Etna at any time without notice or cause."

I further understand and agree that any offer of employment Etna may make to me (and, if I am hired, my continued employment) will be contingent upon my taking and passing physical examinations and drug testing and that any changes which may occur in my application during employment will be reported by me within 48 hours to the Borough."

"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 Etna in any way."

"I herby acknowledge that I have read this section of the employment application and full understand the meaning and effect of signing this form."

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