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ALERT!! Development site for Susquehanna County

Employment Application Form


Instructions for filling out form go here. 



Skills and Qualifications
Education
High School
College
Other
Work Experience (List in order, last or current employer first)
Employer 1
Employer 2
Employer 3
Personal References (Not Former Employers or Relatives)
Reference 1
Reference 2
Reference 3
I authorize Susquehanna County to complete a criminal background check, check references and verify information provided in the employment process. I consent to a pre-employment drug test and I understand that if I am given an offer of employment it will be conditioned upon my completion of a medical examination / psychological examination (if applicable).
By typing your name in this box you are electronically signing this application.

Applications will be retained for one (1) year from the date received, after which applicant must reapply. 

In complying with the New Hire Provisions of the Personal Responsibility and Work Opportunity Act of 1996, we will furnish the name, address, social security number, date of birth and date of hire of any applicant that is hired to the Commonwealth of PA Department of Labor and Industry.

This application is available in other formats. Applicants requiring accommodation in the application or hiring process should contact the Human Resource Department.


**Veterans' Preference

You may receive preference in hiring if you are: a veteran, the widow or widower of a veteran, or the spouse of a disabled veteran.  Your separation must have been under Honorable or other acceptable conditions.

The following documents will need to be submitted with your application:

  • Veterans: Photocopy, not the original, of the DD Form 214 or other military document showing dates of entry and separation and character of service.
  • Widow and Widowers: Photocopy, not the original, of the spouse's DD Form 214. A certified copy (not a photocopy) of the death certificate.
  • Spouses of Disabled Veterans: Photocopies, not the originals, of DD Form 214; a Veterans' Administration letter, dated within the past six months, verifying that the veteran is receiving compensation for a service-connected disability; and a signed statement from the disabled veteran showing the social security number and agreeing to transfer credit to you.

Employment Application Form