Request For Employment

Name of applicant: ___________________________________

Number: ___________________________________________

Address: ___________________________________________

Address: ___________________________________________

To: (employer's name): _______________________________

(address): __________________________________________

(city, state, zip): _____________________________________

I am eligible for parole on (date): _______________________

I seek full time employment as (job or jobs):  __________________________________________________. I am a reliable worker who will adhere to all the work-place rules. I will be under the strict supervision of the Pennsylvania Board of Probation and Parole. I have the following work experience: __________________________________________________

__________________________________________________.

I have training and/or skills including: __________________________________________________

__________________________________________________.

I am (age) __________ years old. You will find that I am a punctual, hard working and dependable employee. 

If you are able to offer employment to me, please complete and return the enclosed Employment Confirmation Form (pform5). In turn, I will submit it to the Parole Board as part of my Parole Plan.

Respectfully Submitted:

(sign) ________________________________________