326 East Main St Bloomsburg, PA 17815 570.387.9000 (fax) 570.387.1773
Citiscape 22 West Broad St. Hazleton, PA 18201 570.459.5627 (fax)570.459.5629
100 North Centre St. Pottsville, PA 17901 570.622.0300 (fax): 570-622-5076
Notice to all applicants
Pre-Application
PHONE:
ADDRESS:
What positions are you interested?
What shifts are you interested in working?
Do you have two forms of identification? Yes No
Do you have reliable transportation? Yes No
Can you work in a dusty environment? Yes No
Can you do repetitive work with your hands? Yes No
Can you stand for long periods of time? Yes No
Can you bend repeatedly? Yes No
Can you reach above your head? Yes No
Can you freely rotate your upper body? Yes No
Have you had any past health problems that would limit the use of your hands, lifting or bending? Yes No
Can you work overtime, if necessary? Yes No
Can you go out to work on short notice? Yes No
How far are you willing to travel?
How long were you employed at your last job?:
Why did you quit your last job?
Copy and paste your Resume in the block below:
www.RitaLong.com
