Employment Application

Please complete the employment application form below to apply online. If you prefer, you may also print a copy of the application and mail the completed form to the address listed below.

Lycoming Housing Authority
1941 Lincoln Drive
Williamsport, PA

1
Applicant Information
2
Education Information
3
References
4
Previous Employment
5
Military Service
6
Disclaimer & Signature

1/6

Applicant Information

Applicant information

Last name*

M.I.

First name*

Street address*

Apartment / unit #

City*

State*

ZIP code*

Phone*

Email*

Date available

Desired salary ($)

Position applied for*

Eligibility

If yes, when?

If yes, explain

High school

High School Name

Street address

City

State

ZIP code

From

Did you graduate?

Diploma

College

College Name

Street address

City

State

ZIP code

From

Did you graduate?

Degree

Other education

Other School Name

Street address

City

State

ZIP code

From

Did you graduate?

Degree

20%

Please list three professional references.

Reference 1

First name*

Last name*

Relationship

Company

Phone

Street address

City

State

ZIP code

Reference 2

First name*

Last name*

Relationship

Company

Phone

Street address

City

State

ZIP code

Reference 3

First name*

Last name*

Relationship

Company

Phone

Street address

City

State

ZIP code

40%

Previous employment 1

Company

Phone

Street address

City

State

ZIP code

Supervisor

Job title

Responsibilities

Reason for leaving

From

Contact supervisor?

Previous employment 2

Company

Phone

Street address

City

State

ZIP code

Supervisor

Job title

Responsibilities

Reason for leaving

From

Contact supervisor?

Previous employment 3

Company

Phone

Street address

City

State

ZIP code

Supervisor

Job title

Responsibilities

Reason for leaving

From

Contact supervisor?

60%

Military service

Branch

From

Rank at discharge

Type of discharge

If other than honorable, explain

80%

Disclaimer

Lycoming County Housing Authority / LHFI is an equal opportunity employer and does not discriminate on the basis of race, color, national origin, age, religion, creed, disability, veteran’s status, gender, sexual orientation or genetic information.

By signing below, I certify all information within this application is correct to the best of my knowledge. I acknowledge that providing false information is grounds for refusing to hire me, or for termination should I be hired.

In consideration of my employment, I agree to conform to the Authority’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the Authority’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the Authority.

Signature

Applicant Signature

100%