Online Application

Required information

Name
Email
Phone
Address 1
Address 2
City
State
Zip Code
Position(s) applied  for or type of work  desired
Employment  status desired		Select one Full-time Part-time Temporary
Desired start date
Your comments
select one Yes No		Are you able to meet the attendance requirements?
select one Yes No		Are you able to work overtime, if required?
select one Yes No		Can you travel if required by this position?
select one Yes No		Have you ever been previously employed by our organization?
select one Yes No		Can you submit proof of legal employment authorization and ID?
select one Yes No		If you are under 18, can you furnish a work permit if it is required?
select one Yes No		Can you safely lift 100 pounds?
select one Yes No		Have you ever had a back injury?
select one Yes No		Do you have a clean driving record?
select one Yes No		Do you have transportation to and from work, if hired?
select one Yes No		Can you drive a standard/stick-shifting vehicle?
select one Yes No		Are you able to work outdoors all year round?
select one Yes No		Do you have a problem with heights?
select one Yes No		Do you consider yourself to be mechanically inclined?
select one Yes No		Have you been convicted of a crime or pleaded guilty or nolo contendere to a felony within the past 7 years?
If yes, please explain  (a conviction will not  automatically bar  employment)
Summarize any job-related training , skills, licenses,  certificates, and/or  other qualifications
Employment History		Please provide all employment information for you past 3 employers starting with the most recent.
1 Employer name
Position held
Start date
End date
Salary
Supervisor name
Supervisor title
Employer phone
Address 1
Address 2
City
State
Zip code
Job summary
Reason for leaving
2 Employer name
Position held
Start date
End date
Salary
Supervisor name
Supervisor title
Employer phone
Address 1
Address 2
City
State
Zip code
Job summary
Reason for leaving
3 Employer name
Position held
Start date
End date
Salary
Supervisor name
Supervisor title
Employer phone
Address 1
Address 2
City
State
Zip code
Job summary
Reason for leaving
Educational History		Provide names and locations of educational instructions attended.
High school
City
State
Dates attended		to
Course of study
Degree earned
College
City
State
Dates attended		to
Course of study
Degree earned
Technical training
City
State
Dates attended		to
Course of study
Degree earned
Other education
City
State
Dates attended		to
Course of study
Degree earned
Education comments
References		List 3 references (do not include relatives or employers):
1 Name
Phone
2 Name
Phone
3 Name
Phone
Online signature		By entering my name in the online signature box below, I hereby authorize B.L. Myers Bros of PA and its representatives, to contact, obtain and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references.  I also hereby release from liability B.L. Myers Bros of PA and its representatives, for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.      Online signature
I Accept   Please read the following before submitting your online application		By selecting the I Accept button below, I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. If I am employed, I acknowledge that there is no specified length of employment and that his application does not constitute an agreement or contract for employment. Accordingly, either the employer or I can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law. I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA. I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment. I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.