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John W. Gleim
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  • Services
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  • Why Gleim?
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  • 717.243.7160

Employment Application

We are committed to being an Equal Opportunity Employer and do not believe in discrimination against any applicant or employee on the basis of Race, Religion, Nationality, Gender, Sexual Orientation, Gender Identity or Expression, Genetic Information and Testing, Family and Medical Leave, Age, Disability, Veteran/Military Status, Marital Status or other status protected by Federal or State Law. Furthermore, we prohibit Retaliation against a person who files a charge of discrimination or opposes unlawful employment practices.

"*" indicates required fields

1Personal Information
2Education
3Work Experience
4References & Release
Please fill in all areas requested and sign the application. Applicants may be tested for illegal substances.
Name*
MM slash DD slash YYYY
Address*
Days available to work (please check all that apply)*
Type of employment (check all that apply)*
MM slash DD slash YYYY
Please fill in all areas requested and sign the application. Applicants may be tested for illegal substances.
Have you ever applied with our Company before?*
Are you over 18 years of age?*
Are you a US citizen?*
Are you legally eligible to work in the US?*
Education*
Type of School
Name of School
Address
Years Completed
Major/Degree
Additional Education
Type of School
Name of School
Address
Years Completed
Major/Degree
Additional Education
Type of School
Name of School
Address
Years Completed
Major/Degree
Have you ever been charged with a felony or misdemeanor?*
Do you have any allergies or medical conditions that would preclude you from operating a motor vehicle or piece of machinery?*
Please fill in all areas requested and sign the application. Applicants may be tested for illegal substances.

Work Experience

Employer Address*
Employment Dates*
Employed Start Date
Employed End Date
 

Employer Address
Employment Dates
Employed Start Date
Employed End Date
 

Employer Address
Employment Dates
Employed Start Date
Employed End Date
 

May we contact your present employer?*
Did you have help completing this application?*
Have you ever been in the U.S. Armed Forces?*
If discharged from the U.S. Armed Forces, were you honorably discharged?
Max. file size: 50 MB.
Please fill in all areas requested and sign the application. Applicants may be tested for illegal substances.
Reference 1*
List the information for three (3) references for persons not related to you whom you have known for at least 1 year.
Name
Phone Number
Address
Relationship
Job Title of Reference
 
Reference 2
Name
Phone Number
Address
Relationship
Job Title of Reference
 
Reference 3
Name
Phone Number
Address
Relationship
Job Title of Reference
 

Driver's License Information

Do you have a current, valid driver’s license?*
Driver's License*
Driver's License No.
State Issued
Expiration Date
Class
 
Is your driver’s license revoked or suspended?*
Have you had any motor vehicle accidents in the last three (3) years?*
Have you had any moving violations in the last three (3) years?*

Consent*
I certify that the facts contained in this employment application are true, complete and correct to the best of my knowledge. I understand that any false information, omission or misrepresentation may be cause for refusal to hire or termination, if I have been employed by the Company, no matter on what date discovered by the Company.

I authorize the Company to contact my references to obtain information about myself and my character. I further authorize the Company to thoroughly investigate and perform background/criminal background checks as necessary to obtain information regarding my employment history, my educational history, character, and any other necessary information in order to determine my suitability for employment with the Company.

I understand and agree that nothing contained in this application, or conveyed during interview, is intended to create an employment contract, unless a contract is memorialized in writing and signed by all relevant parties. I understand and agree that, if hired, my employment is “at will” in accordance with the laws of Pennsylvania, without fixed term, and may be terminated at any time, with or without cause or prior notice, at the option of either myself or the company.

I understand that completing this form does not indicate that there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. The Company retains the right to revise it policies or procedures, in whole or in part, at any time.
Name of Applicant*
Your name serves as an electronic signature to this document.
MM slash DD slash YYYY

625 Hamilton Street | Carlisle, PA 17013

717.243.7160
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