Employment Application

Debra's Glass
255 N. Pleasant Ave.
Dallastown, PA 17313
(717)-244-4622

Personal Information

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone/Mobile

Position Information

Position Applying For

Date You Can Start

Are you employed now?

Yes

No

May we inquire on your present employer?

Yes

No

Are you eligible to work in the United States?

Yes

No

Are you over the age of 18? If not, do you have an employment age certificate?

Yes

No

Have you ever been convicted of or pleaded no contest to a felony?

Yes

No

Explain:

Do you know anyone presently employed at Debra's Glass?

Yes

No

Who?

Do you have a valid driver's license?

Yes

No

Driver's License State

Driver's License #

Education

High School Name

Diploma

Yes

No

College

Major

Degree

Yes

No

Trade, Business, or Other

Major

Degree/Diploma

Yes

No

Special Skills and Qualifications

Employment History

Start with the present or last position.

Employer #1

Address

Address Line 1

City

State

Zip Code

Phone/Mobile

Position

From

To

Salary

Reason For Leaving

Employer #2

Address

Address Line 1

City

State

Zip Code

Phone/Mobile

Position

From

To

Salary

Reason For Leaving

Employer #3

Address

Address Line 1

City

State

Zip Code

Phone/Mobile

Position

From

To

Salary

Reason For Leaving

References

Must not be relatives or your former employers.

Name

Address

Address Line 1

City

State

Zip Code

Phone/Mobile

Occupation

Name

Address

Address Line 1

City

State

Zip Code

Phone/Mobile

Occupation

Name

Address

Address Line 1

City

State

Zip Code

Phone/Mobile

Occupation

Upload Resume (.pdf, .doc, .docx files accepted)

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Attestation

Please check the box to confirm that you understand the following statements.

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not being considered for employment or for immediate termination of employment at any point in the future. I authorize the verification of any or all information listed above.

I agree

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated at any time without any prior notice.

I agree

I understand that if I am offered a position, a pre-employment drug screen and background check will be performed.

I agree

4.5

Google Reviews

Office

Request a Quote

Contact Us

Phone: 717-244-4622 Fax: 717-244-1033

Working Hours

Office

Request a Quote

Contact Us

Phone: 717-244-4622 Fax: 717-244-1033

Working Hours

Debra's Glass
255 N. Pleasant Ave.
Dallastown, PA 17313
(717)-244-4622

Personal Information

Position Information

Education

Employment History

References

Attestation

4.5

Google Reviews

Office

Request a Quote

Contact Us

Phone: 717-244-4622 Fax: 717-244-1033

Working Hours

Office

Request a Quote

Contact Us

Phone: 717-244-4622 Fax: 717-244-1033

Working Hours