Name *

First Name

Last Name

Phone Number *

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you currently possess Act 120 certification or its equivalent? If yes, upload certificate at the bottom of the page. *

ACT 120 IS NOT REQUIRED TO APPLY TO THIS POSITION

Yes

No

Are you claiming veteran's preference? (If yes, upload DD214 at bottom of page). *

Yes

No

Date of Birth *

MM

DD

YYYY

APPLICATION FORM WAIVER. In exchange for the consideration of my job application by the City of Allentown, (hereinafter called "the City"), except where collective bargaining agreements exist, I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other City practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of the City of Allentown, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned. Both the undersigned and the City of Allentown may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the City may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the City permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the City from any liability as a result of such contract. I also understand that (1) the City has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations. I understand that, in connection with the routine processing of your employment application, the City may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the City will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. I further understand that my employment with the City shall be probationary for a period of one hundred-eighty (180) days, and further that at any time during the probationary period, or thereafter, my employment relation with the City is terminable at will for any reason by either party *

I AGREE

I DO NOT AGREE

I ACKNOWLEDGE THAT I NEED TO BRING A COMPLETED MEDICAL CLEARANCE, HOLD HARMLESS FORM, AND INFORMED CONSENT WITH ME TO THE PHYSICAL AGILITY TEST *

YES, I ACKNOWLEDGE

NO, I DO NOT