Employment Application | Spectrum Community Services

Date *

Position(s) applying for: *

Preferred Geographic Location: *

Source / Referred by:

Were you ever employed by Spectrum Community Services Inc? *

Yes, when?Yes, when?

No

Personal Data

Name *

First

Last *

Last

Telephone Phone *

Address *

Address Line 2

City *

State *

Postal Code *

Email *

Have you lived in Pennsylvania for at least two years prior to a potential start date? *

Yes or No. If No, indicate how long you have been residing in Pennsylvania as of the date of this application.

Do you have the legal right to work and remain in the United States? *

Yes

No

Are you able to perform the duties of the position you have applied for in a reasonable and safe manner? *

Yes

No, please explainNo, please explain

Did you serve in any military branch? *

Yes, in what capacityYes, in what capacity

No

Have you ever been convicted of a crime? *

Yes, please explain:Yes, please explain:

No

(Please note: Conviction will not necessarily disqualify applicant.)

Do you have a valid driver's license? *

Yes, list state & exp dateYes, list state & exp date

No

Have you ever been terminated or suspended from any previous employment? *

Yes, describe the circumstancesYes, describe the circumstances

No

Education and Training

High School Diploma *

Yes, please list name of school, location and course of studyYes, please list name of school, location and course of study

No

College Diploma

Yes, please list name of school, location and course of studyYes, please list name of school, location and course of study

No

Other Diploma

Yes, please list name of school, location and course of studyYes, please list name of school, location and course of study

No

Certificates / licenses:

(List specifics/Identify)