E.D.C.O.ParkEmployment Application

204-B South Jackson Street, Evans City, PA 16033(724) 538-8320 ext. 221

Applicant Information (Please Print or type)

Last Name / First / M.I. / Date
Street Address / Apartment/Unit #
City / State / ZIP
Phone / Cell / E-mail Address
Date Available / Social Security No. / Desired Salary
Drivers License Number / State, Class, and Expiration / Restrictions
Are you related to anyone working for E.D.C.O.Park? / YES / NO / If yes, names and relationships
Position Applied for
Professional Licenses, Memberships, or Certificates
Other Job Related Training
Remarks
Are you a citizen of the United States? / YES / NO / If no, are you authorized to work in the U.S.? / YES / NO
Are you under 18 years of age? / YES / NO
Have you ever worked for this company? / YES / NO / If yes, when?
Have you ever been convicted of a felony or misdemeanor? / YES / NO / If yes, explain

Education

High School / Highest Completed Grade
From / To / Did you graduate? / YES / NO / Degree
College / Major
From / To / Did you graduate? / YES / NO / Degree
Other
/ Major
From / To / Did you graduate? / YES / NO / Degree

References

Please list three professional references.
Full Name / Relationship
Company / Phone / ( )
Address
Full Name / Relationship
Company / Phone / ( )
Address
Full Name / Relationship
Company / Phone / ( )
Address

Previous Employment

Employer
/ Phone / ( )
Address / Supervisor
Job Title / Salary / $ / Hours Per Week
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Employer
/ Phone / ( )
Address / Supervisor
Job Title / Salary / $ / Hours Per Week
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Employer
/ Phone / ( )
Address / Supervisor
Job Title / Salary / $ / Hours Per Week
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO

Military Service

Branch / From / To
Rank at Discharge / Type of Discharge
If other than honorable, explain
E.D.C.O.Park is an equal opportunity employer. We encourage all persons to file applications with us and we do not discriminate on the basis of race, color, religion, age, se, national origin, veteran status, and mental or physical disability.
All job offers are contingent upon the successful completion of a background process, which may include a police records check and a medical examination which includes drug screening

Disclaimer and Signature

I hereby certify that all statements made in this application are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature / Date