Once each form is completed click on the submit button to process to the next form.
You will need to place your name at the top of each form.
| Position applied for: |
|
| Date: (dd/mm/yyyy) |
|
| Which residence(s) are you applying for: |
IntegraCare Corporation
Magnolias of Chambersburg
Magnolias of Lancaster
Newhaven Court at Clearview
Newhaven Court at Lindwood
The Pines of Mount Lebanon
The Residence on Fifth
The Residence at Willow Lane
Rexford Place
Willow Heights
The Woods at Cedar Run
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| Name: (First, Last, Middle Initial) |
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| Home Phone Number: |
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| Address1: (Street, City, State, Zip, Country)
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| Address2: (Street, City, State, Zip, Country)
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| If necessary, the best time to call you at home is: |
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May we contact you at work?
Yes
No |
If yes, work number and best time to call
|
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Area Code/Phone Number:
|
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If you are under 18, can you furnish a work permit?
Yes
No |
Have you filed an application here before?
Yes
No |
If yes, give date
|
from:
to:
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Have you ever been employed here before?
Yes
No |
If yes, give date
|
from:
to:
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Are you legally eligible for employment in this country?
(Proof of U.S. citizenship or immigration status will be required upon employment)
Yes
No |
| Date available for work? |
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| Type of employment desired: |
Full Time
Part-Time
Temporary
Seasonal |
Are you on a lay-off and subject to recall?
Yes
No |
Will you relocate if job required?
Yes
No |
Will you travel if job required?
Yes
No |
Will you work overtime if job required?
Yes
No |
Have you ever been bonded?
Yes
No |
Have you been convicted of a felony, misdemeanor or summary offense?
(Such conviction may be relevant if job related, but does not bar you from employment.)
Yes
No |
Have you ever been convicted of a violent crime?
Yes
No |
Have you ever been dismissed from employment due to abuse of clients, residents, or patients?
Yes
No |
If yes to any of the above, please explain?
|
Do you have any friends or relatives working for IntegraCare Corporation or any ICC owned or managed residence?
Yes
No |
If yes, please list name(s) and relationship?
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| Driver's license number (If required by job) |
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Driver's license state
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