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Section II - Education

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Highest grade level successfully completed

Please specify other

Specialized course/training/certification/College degree(s) held?

Do you have access to a computer?

YesNo

Section IV - Physical Needs Assessment

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Do you need special accommodation(s), such as wheelchair access, to perform the employment you are seeking?

YesNo

What accommodations do you require?

Do you need supportive services?

YesNo

Please describe support services needed:

Have you been to CareerLink?

YesNo

Are you enrolled at CareerLink?

YesNo

If you have not yet gone to CareerLink, it would be to your advantage to do so for additional help in finding employment.

Section V - Job Search Information

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I can use the following for transportation (choose all that apply):

Select All (Uncheck to clear all)

I prefer to work (choose all that apply):

Select All (Uncheck to clear all)

Section VI - 55+ Job Bank Program

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How did you learn about the 55+ Job Bank?

Please list how you learned about the 55+ Job Bank:

Are you aware of the Career Resource Center?

YesNo

Are you using the Career Resource Center?

YesNo

If you have not yet gone to CareerLink, it would be to your advantage to do so for additional help in finding employment. It is located at 1046 Manheim Pike, open M-F, (717) 509-5613.

Section VII - Work History

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STARTING WITH YOUR MOST RECENT EMPLOYMENT

1. Employer Name

1. Job Title

1. Employment Start Date

1. Employment End Date

1. Employer Address

1. Employment Status

1. Pay Rate (Hourly or Salary)

1. Duties and Responsibilities

1. Reason for leaving

______________________________________________________________________________________

2. Employer Name

2. Job Title

2. Employment Start Date

2. Employment End Date

2. Employer Address

2. Employment Status

2. Pay Rate (Hourly or Salary)

2. Duties and Responsibilities

2. Reason for leaving

______________________________________________________________________________________

3. Employer Name

3. Job Title

3. Employment Start Date

3. Employment End Date

3. Employer Address

3. Employment Status

3. Pay Rate (Hourly or Salary)

3. Duties and Responsibilities

3. Reason for leaving

Section VIII - References

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List 3 persons not related to you whom you have known for at least 1 year. At least 2 should be work references.

1. Reference Name

1. Reference Phone Number

1. Reference Address

1. Reference City

1. Reference State

1. Reference Zip Code

______________________________________________________________________________________

2. Reference Name

2. Reference Phone Number

2. Reference Address

2. Reference City

2. Reference State

2. Reference Zip Code

______________________________________________________________________________________

3. Reference Name

3. Reference Phone Number

3. Reference Address

3. Reference City

3. Reference State

3. Reference Zip Code

Section X - List Your Job Preferences

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You MUST put in at least one choice

1st Preference *

2nd Preference

3rd Preference

4th Preference

Add a 5th preference

5th Preference

Add a 6th preference

6th Preference

We will not refer you to any jobs without having met you. AGE 55 YEARS OR OLDER AND CAN PROVIDE PROOF OF AGE, RESIDENCY and INCOME.

Section XI - Resume

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Please upload your resume, if you have one, using the file upload below.

Upload Resume
Drag and Drop File Here:

Section XII - Authorize and Sign

I hereby authorize the Office of Aging to share information provided with potential employers with the understanding that confidential information will remain secure. I understand 55+ Job Bank is a referral service only and that the Office of Aging cannot be held responsible for employer-employee problems arising after employment.

Further, if I am eligible for, and choose to participate in, any government subsidized program administered by the Lancaster County Office of Aging, I understand the information provided will be used to construct my Individual Employment Plan after enrollment.

The information provided is correct and true. *

Printed Name of Applicant

Signature of Applicant

Create a New Employment Application

Fill out the Employment Application details in the form below

Section I - Personal Information

Section II - Education

Section III - Senior Community Service Employment Program

Section IV - Physical Needs Assessment

Section V - Job Search Information

Section VI - 55+ Job Bank Program

Section VII - Work History

Section VIII - References

Section IX - Employment Skills

Section X - List Your Job Preferences

Section XI - Resume

Section XII - Authorize and Sign

Create a New Employment Application

Enter Your Bank Account Information

Enter Your Micro Deposit Amounts To Verify Your Bank Account

Fill out the Employment Application details in the form below

Section I - Personal Information

Section II - Education

Section III - Senior Community Service Employment Program

Section IV - Physical Needs Assessment

Section V - Job Search Information

Section VI - 55+ Job Bank Program

Section VII - Work History

Section VIII - References

Section IX - Employment Skills

Section X - List Your Job Preferences

Section XI - Resume

Section XII - Authorize and Sign

Signature

Extract Data from Filled PDF