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City of Harrisburg

info@harrisburgpa.gov

10 North 2nd St., Harrisburg, PA, 17101, US

717-255-3040

Form Section 1

Full Time Employment Application

1. Personal Information

Your Full Name *
Your Address *
Are you authorized to work in the United States of America? *

2. Type of Work Desired

3. Military Status

Have you served in the U.S. Armed Forces? *
Branch of service
Form Section 2

4. Education

High School *
Did you graduate? *
Business/Technical
Did you graduate?
College/University
Did you graduate?
Additional School

5. General Information

Certain jobs with the City require a physical examination. If the position for which you are being considered requires a physical examination, are you willing to submit to an exam, at the City’s expense, after a conditional job offer has been made to you? *
All new full-time employees must pass a pre-employment controlled substances test. Are you willing to submit to a pre-employment controlled substances test, at the City’s expense, after a conditional job offer has been made to you? *
City employment requires a background investigation. Are you willing to have a background investigation done? *
Are you willing to accept the currently established wage for the job(s) you are seeking? *
Are you willing to work rotating shifts? *

6. Licenses, Certificates, Special Qualifications and/or Skills

7. Foreign Language

Indicate any foreign language skills you have and rate your level of knowledge for each. If you have no foreign language skills skip this section.

Form Section 3

8. Employment History

Beginning with your most recent job, list your entire work history for the past ten (10) years, including full-time, part-time, temporary and seasonal employment AND all periods of unemployment. List full addresses and zip codes.

Upload your resume (if applicable). If you have no resume to upload please fill out as many employer sections as possible.
Present or Most Recent Employer
Employer Address
Job Information
Employer #2
Employer Address
Job Information
Employer #3
Employer Address
Job Information
Have you EVER been fired, asked to resign, suspended for cause, or subjected to disciplinary action while in any position? *
In the past three (3) years from the date of application, have you applied for employment with the City of Harrisburg? *
In the past three (3) years from the date of application, have you been disqualified from making application for employment with the City of Harrisburg? *
Have you EVER worked for the City of Harrisburg? *
Form Section 4

9. Vehicle Operator's License

List the following information for ALL vehicle operator’s licenses you now hold or have held in the last 3 years from the date of application.

Additional Information *
Additional Information
Additional Information
In the past three (3) years from the date of application, have you received a traffic citation for a moving violation? *
In the past three (3) years from the date of application, has your driver’s license been suspended, restored or administratively restricted for non-medical reasons? *
Sign Here *
Receipt
You will be provided with a Receipt upon submission.