Employment Application
Are you currently employeed?
Desired Employment
Do you have a copy of a TB test that is *not* over 1 year old?
Will you work overtime if required?
Do you have a car?
Do you have reliable transportation?
Are you willing to travel if required?
Have you ever been bonded?

Previous Employment

Please list your most recent job information first

References

Please list three people that are *not* related to, that you have known for at least 1 year.

Conditions of Employment 

Please read the following information and sign below
1. Reporting to work with impaired abilities; or the possession, consumption, or distribution of drugs or alcohol on company premises and/or worksites, shall be grounds for disciplinary action, including discharge. A condition of employment includes the willingness on the part of the applicant or employee to agree to physical examination, polygraph, and/or substance testing if requested by the company. We are committed to operating a drug-free workplace. Violations of our drug and alcohol policy will result in dismissal.
2. It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign anytime, the employer reserves the right to terminate my employment at any time if I break any of the policies or procedures. 
3. I give the employer the right to investigate all police, driving, and personal records and references, if job-related. I hereby incur the liability of the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information
4. I understand that the employer is an Equal Opportunity Employer and does not discriminate in employment and no question on its application is used for the purpose of limiting or excusing any applicants consideration for employment on a basis prohibited by local, state or federal law.
5. Any controversy of any kind arising between the parties under this agreement or otherwise (or any agent, officer, director or affiliate of any party), including but not limited to common law, statutory, tort or contract claims, will be submitted to mediation and failing settlement in mediation, to binding arbitration. Unless otherwise agreed on mediation and arbitration designated by staff professionals will govern any mediation and arbitration. The parties will select the mediator or arbitrator from the designated company.
6. This application is current for 60 days and if I haven't heard from the employer, it will be necessary to fill out a new application
7. I understand that there has to be a criminal history check before offering me employment. I, the undersigner, hereby authorize Partner in Care Home Care LLC to conduct any verify my criminal history by performing a criminal history check 

*** By signing I understand that everything I have said is true and accurate and that any omissions or inaccuracies could impact the status of any prospective or future employment.

Your Signature

Attachments

If you have a resume you would like to upload, please upload below

Upload Resume
Upload supported file (Max 15MB)

If you have a copy of TB test that is *not* over 1 year old, please attach below

Upload Copy of TB Test
Upload supported file (Max 15MB)

If you have the certification from the PA State Competency Exam please attach below

Upload Certification
Upload supported file (Max 15MB)
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