Employment Application

Brubaker Inc. Employment Application

  • Phone Numbers

  • Note: Proof of citizenship or immigration status will be required of you upon your employment. (An I-9 form must be completed.)
  • Note: A criminal background check may be conducted by the Pennsylvania State Police as required by Act 34. Employees may be required to complete Pennsylvania Child Abuse History Clearance forms as required by Act 151.


    For each school that you attended below, please list the NAME, ADDRESS, COURSE OF STUDY, YEARS COMPLETED, and DIPLOMA/DEGREE.

    Start with your present or last job. Include all employment and be complete, including any job-related military service assignments and volunteer activities. You may exclude organizations which indicate age, race, color, gender, national origin, disability, or protected status.



    (please do not list relatives)
  • list name, address, and contact phone number
  • list name, address, and contact phone number

    1. Completeness and acuracy of information. I represent that all of the information now and hereafter given by me in support of my application for employment is true and complete. I understand, that if I am hired, any false or misleading information in support of my application may subject me to discharge at any time during the period of my employment.
    2. Authorization for release of information and release from liability. I authorize you to verify any of the information given during the application process with appropriate individuals, companies, institutions, or agencies and I authorize them to release such information as you require, including my prior disciplinary employment record, without any obligation to give me written notice of disclosure. I hereby release you and them from any liability whatsoever as a result of such inquiries and disclosures. A photocopy or other electronic reproduction of this authorization/release is binding, and may be relied upon.
    3. Employment at will. I understand that if I am employed, I will be an employee at will. This means that either the employer or the employee mey terminate the employment relationship with or without cause at any time.
    4. No written, oral, or implied contracts. I understand that any written Company documents, oral statements, or formal or informal policies are not to be construed as granting an express or implied employment contract and that I am not entitled to rely upon any such documents, statements or Company policies as stating employment terms. The employment relationship with the Company may be modified only in writing directed to me by the President of the Company.
    5. Benefits may be altered. I understand that the Company at its option may change, delete, suspend, or discontinue any part or parts of its benefit program at any time without prior notice, both while persons are actively employed and while retired or otherwise separated from employment with the Company.
    6. I understand that a test for drug and alcohol misuse may be required as part of the interview process, and I hereby authorize the release of test results to the Company. I hereby consent to the perpformance of such medical examination and testing. I waive all claims arising out of these procedures against the Company and those performing the examination and tests. I understand and consent that as a condition of continued employment, I will submit to drug and alcohol testing in the future. I authorize the release of any such subsequent testing to the Company and waive all claims against it or those performing the examination and tests. I understand that I will be subject to immediate termination for failing to submit to examinations or testing.
    7. If an employment relationship is established, I agree to wear or use all protective clothing or devices as may be required by the Company and to comply with all safety policies and procedures.
    8. I understand that this employment application that I submit is only valid for 30 days.

    I acknowledge that I have read and understand the above statements in their entirety, and have had the opportunity to ask questions regarding any aspect of this application, and that I accept the above terms.