Personal Information First Name: *M.I.: *Last Name: * Street Address: * City: *State: *Zip Code: * Email Address: * Telephone: *Cell Phone: * Position Applied For: * List experiences, skills, or qualifications that will be of special benefit in the job for which you are applying. (Please do not list information that discloses your race, ethnic background, or age.):* Educational Background Name of High School: * City: *State: *Zip Code: * Graduate* Yes No GED* Yes No Name of College: City: State: Zip Code: Graduate Yes No Degree: Course of Study: Other: City: State: Zip Code: Graduate Yes No Degree: Course of Study: Professional or Technical Licenses held: License Type: License Number: State: Exp. Date (MM/YY): License Type: License Number: State: Exp. Date (MM/YY): Employment History List your present and past employers below, beginning with the most recent. Please list your last rate of pay and relevant volunteer experience. Name of Company: * Street Address: * City: *State: *Zip Code: * Type of Business: *Telephone: * From (MM/YY): *To (MM/YY): * Job Title: *Rate of Pay: * Name of Supervisor: * Reason for Leaving:* Type of Work You Did:* Name of Company: Street Address: City: State: Zip Code: Type of Business: Telephone: From (MM/YY): To (MM/YY): Job Title: Rate of Pay: Name of Supervisor: Reason for Leaving: Type of Work You Did: Name of Company: Street Address: City: State: Zip Code: Type of Business: Telephone: From (MM/YY): To (MM/YY): Job Title: Rate of Pay: Name of Supervisor: Reason for Leaving: Type of Work You Did: Name of Company: Street Address: City: State: Zip Code: Type of Business: Telephone: From (MM/YY): To (MM/YY): Job Title: Rate of Pay: Name of Supervisor: Reason for Leaving: Type of Work You Did: I hereby give permission to contact the employers listed above concerning my prior work experience.* Please list any employers you do not want Phoebe Ministries to contact: Personal References (Not former employers or relatives) Name: * Street: City: State: Zip Code: Occupation: *Phone Number: * Name: * Street: City: State: Zip Code: Occupation: *Phone Number: * Name: * Street: City: State: Zip Code: Occupation: *Phone Number: * General Information How long have you been a resident of the Commonwealth of Pennsylvania? From (MM/YY): *To (MM/YY): * Are you legally eligible for employment in the USA?* Yes No Will you now or in the future require sponsorship for employment visa status (e.g. H-1B status)?* Yes No Are you over the age of 18?* Yes No Were you previously employed by a Phoebe Ministries community?* Yes No Have you ever been or are you currently assigned to work at any Phoebe Ministries community through another employer or agency?* Yes No If “Yes”, please list the employer or agency(s): Have you ever been bonded?* Yes No Have you ever been dismissed from employment to abuse of clients, patients, or residents?* Yes No Have you ever been convicted of a crime which has not been annulled or expunged or sealed by a court?* Yes No If YES, describe in full: (Note: A conviction will not necessarily bar you from employment. Each conviction will be evaluated separately.) Have you ever been convicted of a violent crime?* Yes No How were you referred to Phoebe Ministries?* Phoebe's Reputation Walk-in Newspaper Phoebe.org Job Fair Employment Agency Employee ReferralName of Employee: Former Employee ReferralName of Former Employee: Indeed.com Careerbuilder.com Linkedin Facebook Other Schedule Preference (Check all that apply) Status* Full Time Part Time Per diem/weekend SeasonalSchedule Availability* Any/All Sunday Monday Tuesday Wednesday Thursday Friday SaturdayShifts* Any 7am - 3pm 3pm - 11pm 11pm - 7am Other USA Military Service Record Were you in the U.S.A. Armed Forces?* Yes No If YES, what branch?: Please identify military training relevant to the position for which you are applying: Release (Please read carefully before signing) I voluntarily give Phoebe Ministries and its communities the right to make a total investigation of my past employment. I agree to cooperate in such investigation and I specifically release Phoebe Ministries, its communities, and its agents and employees from all liability or responsibility in connection with this investigation. I further specifically release from all liability and responsibility all persons or companies supplying such information.* I understand that any offer of employment is contingent upon my satisfactorily completing a physical examination including drug screening, and I specifically consent to such physical examination and drug screening as well as a criminal background check and any other pertinent screenings.* In consideration of my employment, I agree to conform to the rules and regulations of Phoebe Ministries. My employment and compensation can be terminated, with or without cause, and with or without notice at any time, at the option of either myself or Phoebe Ministries.* I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.* Signature: *Date: * Attach Resume Resume Title: Resume: PLEASE NOTE: Upload only MS WORD / PDF / TXT Format - 1MB or smaller Attach Cover Letter (Optional) Cover Note:Cover Letter: PLEASE NOTE: Upload only MS WORD / PDF / TXT Format - 1MB or smaller Submit your application Cancel NOTE: Upon successful completion you will be returned to the previous page and a confirmation will be sent to the email address you provided.