An Equal Opportunity Employer
Lower Gwynedd Township considers applicants for all positions without regard to race, color,
religion, creed, gender, national origin, age, disability or any other legally protected status.
This application will be kept on file for one year. It is the applicant's responsibility to ensure
that a current application is on file.
Position Applying For: ___________________________ Full-Time or Part-Time: _______
Name: ___________________________________
Soc.Sec. #: ___________________
Current Address
___________________________________________________________
(Street)
_____________
______________________________________________
(City)
(State)
(Zip)
Permanent Address ___________________________________________________________
(If other than current)
(Street)
_____________
______________________________________________
(City)
(State)
(Zip)
Home Phone: _________________________ Work Phone: _________________________
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Personal Information
Are you permitted to be lawfully employed in the United States? ____ Yes ____ No
(Proof of citizenship or immigration status will be required upon employment)
Have you ever filed an application with the Township before? ____ Yes ____ No
Have you every worked for the Township before? ____ Yes ____ No
If yes, please state dates of employment and department ________________________________
Are you 18 years of age or older? ____ Yes ____ No
Do you have a valid drivers license? ____ Yes ____ No
Driver's License # _______________________ State: __________ Class/Type: ____________
Personal Information
Are you a veteran of any branch of the United States Armed Forces? ____ Yes ____ No
Have you ever been convicted of a felony or misdemeanor? ____ Yes ____ No
If yes, please explain: __________________________________________________________
__________________________________________________________
(Conviction will not necessarily disqualify applicant from employment.)
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Education
Name & Location of School
*No. Of
Years
Attended
*Did You
Graduate
Concentration
Grammar School
High School
College
Trade, Business or
Correspondence
School
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Former Employer(s) (List Below Last Three Employers, Starting With Last One First)
Date
Month and Year
Name and Address of Employer Salary Position Reason for
Leaving
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References
Name Address Business Relationship Phone Number
Skills & Training
Please list all applicable skills and training received:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Consent
With the submission of this application I certify that all statements are true and correct to the best
of my knowledge and belief. Any misrepresentations or omissions on this application may be
cause for rejection of the application or dismissal after employment.
I authorize the investigation of all statements contained in this application and authorize the
Township to perform a background check as may be necessary in arriving at an employment
decision.
I understand that all employees of the Township are employed at-will, which means that either
the Township or the employee may terminate the employment relationship at any time, with or
without notice and for any and no reason. Employees covered by a collective bargaining
agreement will be governed by the terms and conditions of the contract. No employee or
representative of the Township has authority to enter into any agreement specifying duration of
employment or abrogating an employee's at-will employment status. I understand that this
application is not intended to confer any contractual right or obligation to any party and that the
Township reserves the right to change any practice, policy or procedure with or without notice,
at its sole discretion.
Applicant's Signature Date
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Application and materials can be mailed to:
Lower Gwynedd Township
1130 North Bethlehem Pike
P.O. Box 625
Spring House, PA 19477
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