Application For Employment Page 5


Applicant’s Statement
Please read carefully before signing.
I hereby affirm that the information provided on this Application and accompanying resume (if any) is true and correct to the
best of my knowledge. I also agree that any falsified information or significant omission may disqualify me from further
consideration for employment and may result in my discharge if discovered at a later date. I agree that the Public Utility
Commission shall not be liable in any respect if my employment is terminated because of false statements, answers or omissions.
I authorize the Public Utility Commission to investigate all statements made in this Application, contained in my resume or
made by me in any interview or other document. I authorize the Public Utility Commission to contact my current or most recent
employer for employment verification. I authorize the Public Utility Commission to investigate all statements in this Application
and to secure any necessary information from employers, references, educational institutions and certifying entities. I hereby release
these employers, references, educational institutions and certifying entities from any and all liability arising from their giving or
receiving information regarding my employment history, academic credentials or qualifications, and/or my
suitability for employment.
I understand that I may receive a job offer which is conditioned upon demonstration of my ability to perform the essential
functions of the position for which I have applied.
I understand that this Application will be considered active for a period of one hundred and twenty (120) days. Should I wish
to be considered for employment beyond this period of time, I acknowledge that I must complete another application form or
request in writing that my application continue to be considered.
Signature _____________________________________________
Date ________/_______/________
For Commonwealth Employees Only
I authorize the Public Utility Commission to review my Official Personnel Folder in the Department
of _____________________________________. My Employee Number is __________________________
Signature _____________________________________________
Date ________/_______/________
The Public Utility Commission is an equal opportunity employer dedicated to a policy of nondiscrimination in employment with-
out regard to race, color, religion, creed, gender, national origin, age, physical and/or mental disability, ancestry, pregnancy,
marital, veteran, or any other legally protected status. We value the contribution that the diversity of applicants can bring to the Public
Utility Commission. If you require assistance or a reasonable accommodation in completing this application or any aspect of the
application process, including interviewing, please contact the Human Resources Office.


00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Page of 5