Application Date *
MM slash DD slash YYYY
Date Available for Work *
MM slash DD slash YYYY
* Cell Phone Home Phone Email
Referred by Position(s) Applying for * Pay Expected Hours How did you learn of this position? Are you willing to work overtime? Are you willing to work weekends? Are you legally authorized to work in the U.S.? Are you 18 years of age or older? If not, do you have working papers? Are you willing to travel up to 30 miles? Are you willing to travel between 30 and 60 miles? Have you applied for employment with Mericle within the past year? If yes, provide date and position. Have you ever been employed with Mericle or been assigned to Mericle by a subcontractor? If yes, provide date and position. Criminal Record Screening Have you been a resident of PA for the past two consecutive years?
I understand that any offer of employment by Mericle is contingent upon screening of my work/school/criminal record and personal references. Criminal records may be verified by the State Police or FBI. An affirmative answer to question #2 below will not automatically disqualify you from employment.
Have you ever been convicted of a felony or misdemeanor in any criminal or military court? If yes, list all dates, offenses, and dispositions below. Education History
Please provide education history. (Use the "+" to add more rows)
Special Skills Other Skills
List any other skills not mentioned above.
Professional License(s) and/or Certification(s)
Please list all Professional License(s) and/or Certification(s); include Organization, State where Issued, ID# and Expiration, if any.
All job offers for positions requiring the operation of a company vehicle will be contingent upon confirmation of a valid driver’s license and driver’s background check through the PA Department of Motor Vehicles.
Do you posess a valid driver's license?
Provide issuing state and drivers license number.
Do you possess a valid commercial driver's license? Commercial License Class Military Service
(Complete this section if you served or currently serve in the U.S. Armed Forces)
Start with present or most recent employer.
Company 1 Position Employed (month/year) Rate of Pay Reason for Leaving Company 2 Position Employed (month/year) Rate of Pay Reason for Leaving Company 3 Position Employed (month/year) Rate of Pay Reason for Leaving Company 4 Position Employed (month/year) Rate of Pay Reason for Leaving References
List four (4) supervisors, instructors, or other professional references. Do not include relatives. Use "+" to add rows.
Terms and Conditions *
I understand that, in accepting this application, Mericle is in no way obligated to provide me with employment and that I am not obligated to accept employment if offered, nor does Mericle’s acceptance of this application imply employment.
I understand that Mericle does not guarantee employment for any specific length of time, regardless of quality of work. Therefore, I agree that, if hired, my employment may be terminated by Mericle or me at any time, with or without notice or cause.
I certify that I have fully, honestly, and accurately completed the application in its entirety. All statements made by me on this application are true, correct and complete to the best of my knowledge. I have not withheld anything whatsoever that would, if disclosed, affect this application unfavorably. I fully understand that any misrepresentation or omission in any part of this application, or in any subsequent other written documents that I am required to provide or complete in the course of employment with Mericle may result in the cancellation of this application and, if I am already employed, may result in termination of my employment by Mericle.
I hereby authorize Mericle to thoroughly investigate my references, work record, education and other matters related to my suitability for employment. Furthermore, I hereby authorize my former employers and former educators to disclose to Mericle any and all information related to my past employment and education without giving me prior notice of such disclosure. I certify that I have not been convicted of any crime that would disqualify me from the position(s) for which I am applying and hereby authorize Mericle to request, obtain and examine any and all records relating to a conviction and/or imprisonment for a misdemeanor or felony and all records related to my motor vehicle history. In addition, I hereby release Mericle, my former employers, and all other persons, corporations, partnerships, associations and government agencies from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
I understand that any offer of employment is conditioned on the completion of pre-employment tests, including drug testing. I understand that a satisfactory drug screen is a condition of employment with Mericle.
In consideration of my employment, I agree to conform to the policies and procedures of the company and any specific division policies and procedures. I agree that, if I accept employment with Mericle, I will, as a pre-condition of such employment, produce authentic documents as required establishing my identity and work authorization and sign form I-9 (issued by the Federal Government) verifying, under oath, my employment eligibility.
I hereby acknowledge that I have read the above statements and fully understand the terms thereof.
Use this upload to send your resume and/or cover letter. Allowed file extensions are jpg, pdf, doc, and docx.
Drop files here or
Accepted file types: jpg, pdf, doc, docx, Max. file size: 50 MB, Max. files: 3. Drug Screen Authorization and Consent *
I hereby authorize and give full permission to have Mericle and its authorized medical personnel conduct a screening test using S.A.M.H.S.A. standards for the presence of illegal drugs or prescription medication taken without a prescription.
I will not sue or hold concerned parties responsible for any alleged harm to me or interfering with my obtaining a job or continuing employment due to not submitting to the tests, or as a result of the report of the test. This includes, but is not limited to, possible clerical or laboratory error.
I understand that a job offer may be rescinded if I fail to be tested as scheduled.
I understand that Mericle may require an alcohol/drug screen test at random and/or resulting from an on-the-job accident, injury or equipment damage. My refusal to submit to alcohol/drug testing will be grounds for termination.