Application for Employment

1220 Gallia Street
Portsmouth, OH 45662
(740) 354-5688
www.yourppl.org

Name *

Street Address *

City, State, Zip *

Email Address

You will be sent a copy of this form on submission.

Telephone Number

Are you legally eligible to work in the U.S.A?

Yes

No

Are you of legal age to work?

Yes

No

Position(s) applied for

Are you looking for

Full Time Employment

Part Time Employment

Either

Have we previously employed you?

Yes

No

When did we employ you?

If your application is considered favorably, on what date will you be available to work?

Schedule Restrictions