Career Application * = Required Information How did you hear about us * Our Website Job Advertisement Walk-In Employee Referral Billboards Other REQUIREMENTS TO BE A CAREGIVER Reliable Transportation Child Abuse Clearance PA Criminal Background check Valid Driver's License PPD (2 Step) or Chest X-Ray Physical (Ability to lift, push or pull 25lbs. Ability to bend, twist, stoop, kneel, and reach) Highest Compensation and Paid Overtime. PERSONAL DATA Date of birth Days/hours available for work No Pref Mon Tue Wed Thur Fri Sat Sun Can you work nights? Yes No Employment Desired FULL-TIME ONLY PART-TIME ONLY FULL OR PART TIME When available for work? High School Name of School Location (Complete mailing address) Number of Years Major & Degree College Name of School Location (Complete mailing address) Number of Years Major & Degree Do you have a Driver's License? Yes No What is your means of transportation to work? Driver's License Number State of Issue Have you been a PA resident for the past 2 years? Yes No Office Only (If applying for office position only) Typing Yes No WPM 10-key Yes No Word Processing Yes No WPM Personal Computer Yes No PC Mac Other Skills Please list two references other than relatives or previous employers. Name Position Company Address Telephone Name Position Company Address Telephone An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. WORK EXPERIENCE Please list your work experience for the past five years beginning with your most recent job held. If your were self-employed, give firm name. Attach additional sheets if necessary. Name of Employer Address Name of last supervisor Employment Date From Employment Date To Leave it empty of you're currently working there Starting Salary From Starting Salary To Your last job title Reason for leaving Attach File(s) Name of Employer Address Name of last supervisor Employment Date From Employment Date To Leave it empty of you're currently working there Starting Salary From Starting Salary To Your last job title Reason for leaving Attach File(s) Name of Employer Address Name of last supervisor Employment Date From Employment Date To Leave it empty of you're currently working there Starting Salary From Starting Salary To Your last job title Reason for leaving Attach File(s) Refresh Submit the form please wait ... submitted Unable to submit form
