All applications will be kept on file for a period of six months from the date of original submission.
* Required
* Enter this code here: (Note: If you cannot read the code in the image, Click the button.)
Employee No.
(If previous commonwealth employee)
Work County Preference
* 1st Preference 2nd Preference 3rd Preference
 
Personal Data
* Last Name  
* First Name  
Middle Name
Suffix (JR, SR, II, Etc.)
* Permanent Address  
Apartment
* City  
State Pennsylvania
* Gender
 
* Zip Code  
* County  
* Municipality (CITY/BOROUGH/TOWNSHIP)  
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Home Phone No.  or
Cell Phone No.
 
* Personal Email Address  
* Date of birth:    
List previous name(s) or any alias names
CRIMINAL HISTORY INFORMATION
1. Were you ever convicted of a criminal offense? (criminal offenses include felonies and misdemeanors. Conviction is an adjudication of guilt and includes determinations before a court, a district justice or magistrate, and pleas of nolo contendere (no contest). You may omit only: (1) offenses committed before your 18th birthday which were adjudicated in juvenile court under a youth offender law and (2) any charges which have been expunged by a court or for which you successfully completed an accelerated rehabilitative disposition program. Conviction of a criminal offense is not necessarily a bar to employment; each conviction is considered for its job-relatedness.)
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2. Are charges currently pending against you for a criminal offense? (criminal offenses include felonies and misdemeanors. Criminal charges are not necessarily a bar to employment; each pending charge is considered for its job-relatedness.)
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3. Have you ever forfeited bond or collateral in connection with a criminal offense? (criminal offenses include felonies and misdemeanors. Criminal charges are not necessarily a bar to employment; each pending charge is considered for its job-relatedness.)
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If you answered “yes” to any of the previous criminal offense questions, you must list all convictions and pending charges. For each conviction and pending charge, provide the level of offense (felony or misdemeanor), charge, arrest date, municipality, state, case status, and any disposition (sentence).
Explain the circumstances, including what led up the criminal charges / convictions.
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General Information
1. Are you presently, or have you ever been, an employee of the Commonwealth of Pennsylvania, If yes which Agency?
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If Yes:
Start Date End Date Agency
Start Date End Date Agency
2. Are you retired from the commonwealth? If yes, your retirement will be impacted if you accept employment. Please reach out to your SERS retirement counselor for details.
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3. If employed by the PLCB, would you continue employment with another company? If yes, you will be required to complete form PLCB-1936, Supplementary Employment Request. You will be notified of the approval/disapproval of your request.
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4. Do you have a relative currently working for the PLCB? If, Yes, please state the name and relationship below. Relatives of current employees are not precluded from employment, however, PLCB policy prohibits employees from being hired, evaluated or promoted by immediate family members.
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Name Relationship
5. Can you perform the essential job functions of the position for which you are applying? View position description
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6. Have you ever been dismissed from employment for inefficiency, delinquency, or misconduct, or have you ever been permitted to resign to avoid dismissal? Explain below.
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Explain
7. If you resigned from a position, did the resignation occur after receiving information from your employer indicating you may be disciplined? If so, please explain below.
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Explain
8. Are you currently a high school student?
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Conflict of Interest
A CONFLICT OF INTEREST PROHIBITS EMPLOYMENT WITH THE PENNSYLVANIA LIQUOR CONTROL BOARD IN ACCORDANCE WITH THE LIQUOR CODE SECTION 210. EMPLOYMENT CANNOT BE OFFERED UNTIL THE CONFLICT IS RESOLVED. A “YES” ANSWER TO ANY OF THE FOLLOWING QUESTIONS MAY INDICATE A CONFLICT OF INTEREST.
1. Do you or any member of your immediate family* hold any license issued by the Pennsylvania Liquor Control Board? If so, what type of license(s)?
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2. Do you or any member of your immediate family* hold office in any organization which holds a License issued by the Pennsylvania Liquor Control Board?
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3. Do you or any member of your immediate family* have any direct or indirect interest in any business within the commonwealth dealing in liquor, or alcohol, or malt or brewed beverages, whether as owner, part-owner, partner, member of syndicate, shareholder, independent contractor, manager or agent?
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4. Do you hold any Federal, State, or Local Government job that you were elected to fill (Except Local School Board member)?
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5. Do you hold any job by reason of political appoinment?
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6. Do you hold any job within a political party?
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* MEMBERS OF IMMEDIATE FAMILY CONSISTS OF THE FOLLOWING: SPOUSE RESIDING IN THE PERSON’S HOUSEHOLD AND MINOR DEPENDENT CHILD.
Comments
PLEASE READ CAREFULLY
As a condition to your continued employment, you may be subjected to searches of your person and your possessions when on and/or leaving commonwealth premises. In the event any property of the PLCB is found in your possession, you will be subject to immediate discharge and prosecution under the law.
The PLCB may conduct investigations regarding conviction records. I hereby authorize the PLCB to conduct a comprehensive review of my background to be generated for employment or retention as an employee. I further understand that employment is conditional until results of information given by me here have been reviewed, considered, and verified.
By clicking “Submit Application” you are affirming that: (1) you are the person completing and submitting the form; (2) you consent to interacting or doing business with the PLCB electronically; (3) the information provided on the form is true and correct; and (4) you understand that making false statements or failing to disclose information on the form may disqualify you from consideration for employment, or, if already employed, may result in your dismissal.
The PA Liquor Control Board is proud to be an equal opportunity employer supporting workforce diversity.