Employment Application

Applicant Data:

Answering yes to these questions does not constitute an automatic rejection to employment. Date of the offense, seriousness, and nature of the violation, rehabilitation and position applied for will be considered.


High School







Reference 1

Reference 2


Previous Employment (begin with most recent position)

Employment Record 1

Dates of Employment

Employment Record 2

Dates of Employment

Employment Record 3

Dates of Employment


If you have a separate resume, you may upload it an attach it to this application.


By checking this box, I authorize Bittner Vending to deduct $17.00 (seventeen dollars) from each pay for reimbursement of the Pre-Employment cost to Bittner Vending. Total cost is $170.00 and will be deducted for 10 weeks. If employment is terminated for any reason before the total is paid, the difference will be deducted from the final paycheck.

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or persons from all liability in responding to inquiries in connection with my application.

In the event that I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

Bittner Vending

1120 Miller Picking Road, Davidsville, PA 15928
800-869-7521 • info@bittnervending.com

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