Employment Application

Fill out the following application for employment below to submit your information to us.

Click here if you need a printable version.

Application For Employment
IF YOU REQUIRE ANY ACCOMMODATION(S) DURING ANY OR ALL PARTS OF THE APPLICATION OR PRE-EMPLOYMENT PROCESS, PLEASE INFORM HUMAN RESOURCES SO WE CAN EVALUATE POSSIBLE ACCOMMODATIONS.

Please read all instructions carefully and complete all sections of the application. We will use the information you provide below to determine whether you have the appropriate qualifications, education and experience for a position with St. Joseph.s Center. Complete the entire application truthfully: any falsifications or omissions may be grounds for revocation of any offer of employment or, if discovered after hire, immediate dismissal. If a given question is not applicable to you, you should answer N/A.

St Joseph.s Center is an Equal Opportunity Employer. Employment decisions, including all hiring decisions, are made without regard to race, color, religion/creed, sex/gender, national origin, ancestry, age, pregnancy or family status, disability, genetic information, veteran status, possession of a GED Certificate in lieu of a high school diploma, or any other trait protected by applicable federal, state, or local laws. We strive to hire the hardest working and most qualified individuals.

Employment is contingent upon eligibility to work in the U.S., satisfactorily passing a background check including a drug screen and review of your driving history. All job offers for positions requiring the operation of a St. Joseph's Center Company vehicle will be contingent upon confirmation of a valid driver.s license and driver.s background check through the PA Department of Motor Vehicles.

Your application will be considered active for a period of thirty (30) days. If you make any changes such as address or phone, please notify Human Resources.
General Information
Note: Bold items are required.
Last Name
First Name
Middle Name
Street
City
State
Zip Code
Home Phone
Cell Phone
Social Security
Email Address
Number of years at current address
Position(s) Desired
Pay Expected
Desired Location
Desired Hours/Schedule

How did you learn about this position?

What type of employment do you want?
Date Available

Yes No Are you willing to work weekends?
Yes No Are you willing to work holidays?
Yes No Are you legally authorized to work in the United States
Yes No Are you 18 years of age or older? If not, and you are offered employment, your parent or legal guardian will be required to consent to a background check and pre-employment drug screen.
If no, are you 17 and have graduated or formally terminated high school? Yes No
If the answer to the above question is no, do you have an Employment Certificate ("working papers")? Yes No
Yes No Have you ever been employed by St. Joseph's Center?
If yes, date:
position:
Yes No Have you ever been known by a different name?
List name(s):
Yes No Can you perform the essential functions of the job for which
you are applying with or without reasonable accommodations?
Yes No Do you have any employment commitments or volunteer positions with any other organization or person, including any form of self-employment or contract work, which you expect to continue even if you are hired by St. Joseph's Center.
If yes, please list:
Which position or work commitment will be your first priority?
List all relatives, roommates, or friends working for St. Joseph's Center
Education
 Name & AddressCourse of StudyYears CompletedGraduate?List Degree
High School Yes No
College Yes No
Graduate School Yes No
Other Trade, Business Yes No

Professional License And Certification
TypeOrganizationState IssuedNumberExpiration

References
List Four (4) supervisors, instructors or other professional references and indicate the relationship between you and the listed references. St. Joseph's Center may contact these individuals during the hiring process. Do not list relatives.

NameAddressTelephoneRelationship

Employment History
Start with present or most recent employer and list every employer for whom you have worked in the last 10 years. List your current employer first. We will not contact your current employer without your consent.

Company Name
Telephone
Address
Employed (Month/Year)
From To
Name/Title of Immediate Supervisor
Rate Of Pay
Start Last
Job Title
Reason For Leaving
Job Duties/Responsibilities
May we contact?
Yes No
Are you currently on layoff from your employer and subject to recall? Yes No
Company Name
Telephone
Address
Employed (Month/Year)
From To
Name/Title of Immediate Supervisor
Rate Of Pay
Start Last
Job Title
Reason For Leaving
Job Duties/Responsibilities
May we contact?
Yes No
Are you currently on layoff from your employer and subject to recall? Yes No
Company Name
Telephone
Address
Employed (Month/Year)
From To
Name/Title of Immediate Supervisor
Rate Of Pay
Start Last
Job Title
Reason For Leaving
Job Duties/Responsibilities
May we contact?
Yes No
Are you currently on layoff from your employer and subject to recall3 Yes No
Company Name
Telephone
Address
Employed (Month/Year)
From To
Name/Title of Immediate Supervisor
Rate Of Pay
Start Last
Job Title
Reason For Leaving
Job Duties/Responsibilities
May we contact?
Yes No
Are you currently on layoff from your employer and subject to recall? Yes No

Digital Signature and Acceptance
All job offers for positions requiring the operation of a St. Joseph's Center Company vehicle will be contingent upon confirmation of a valid driver's license and driver's background check through the PA Department of Motor Vehicles.
Please answer the questions below:

Yes No Do you possess a valid PA driver's license?
Yes No Do you presently have auto insurance?

Any offer of employment by St. Joseph's Center is contingent upon screening of your work/school/criminal record and personal references. Criminal records will be verified by the State Police, the FBI, and the Department of Public Welfare's Childline.

Yes No Have you been a resident of PA for the past TWO (2) consecutive years?
Yes No Have you been a resident of PA for the past TEN (10) consecutive years?
Yes No Have you ever been convicted in any state of the United States of a felony or a misdemeanor, or are there any criminal charges pending against you anywhere? An affirmative answer will not automatically disqualify you from employment.
If you answered "yes" above, please list all felonies and misdemeanors of which you have been convicted, and to which you pled guilty or no contest/nolo contendere, including the date of the offense and conviction/plea. Please note that you will not automatically be excluded from consideration based upon the existence of a criminal history. Your suitability for the position sought will be evaluated based upon the circumstances in order to determine whether your criminal history renders you unsuitable for the position for which you applied.

PLEASE READ CAREFULLY

I understand that providing false information on an application for employment is grounds for Saint Joseph's Center to revoke my offer of employment or to terminate my employment in the event that the misrepresentation is discovered after I have been hired.

In submitting this application for employment, I authorize the investigation of all statements contained in it, and I understand that my current and/or former employers may be contacted to provide information concerning my suitability for employment, and that the references whom I have listed above will be contacted concerning my suitability for employment. I expressly authorize St. Joseph's Center to conduct such inquiries, and I release St. Joseph's Center and any responding parties from any and all liability associated with such inquiries.

I understand that in the event that I am hired, I will be hired as an at-will employee, and my employment may be terminated at any time, without or without cause or notice, at the option of either St. Joseph's Center or me. No manager, supervisor or employee of St. Joseph's Center has any authority to enter into an agreement for employment for any specified period of time or to make an agreement for employment that is other than at-will. Only the President of St. Joseph's Center has the authority to make any such agreement, and then, only in writing.

I certify that I have read this entire employment application, including all information that I have provided on the application, and the entire statement set forth immediately above, and have been provided an opportunity to ask any questions before submitting this application. I further certify that all of the information that I have provided on this employment application is true and correct.

Consumer Report and Investigation:Consumer Report Disclosure
St. Joseph's Center, when considering your application for employment, when making a decision whether to offer you employment, when deciding whether to continue your employment (if you are hired) and when making other employment related decisions directly affecting you, may wish to obtain and use a "consumer report" and/or "investigative consumer report" from a "consumer reporting agency". These terms are defined in the Fair Credit Reporting Act ("FCRA"), which applies to you. As an applicant for employment or an employee of St. Joseph's Center, you are a "consumer" with rights under the FCRA.

A "consumer reporting agency" is a person or business that, for monetary fees, dues or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on consumers for the purpose of furnishing "consumer reports" to others, such as St. Joseph's Center (i.e. Criminal Record Checks through the PA State Police or FBI).

A "consumer report" is a written, oral or other communication of any information by a "consumer reporting agency" bearing on a customer's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living, which is used or collected for the purpose of serving as a factor in establishing a consumer's eligibility for employment purposes.

An "investigative consumer report" is a consumer report or portion thereof in which information on a consumer's character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with neighbors, friends, or associates of the consumer reported on or with others with whom he is acquainted or who may have knowledge concerning any such items of information. The Fair Credit Reporting Act provides you with the right to request, in writing within a reasonable amount of time, a disclosure of the nature and scope of the investigation requested.

If St. Joseph's Center obtains a "consumer report" or "investigative consumer report" about you, and if St. Joseph's Center considers any information in the "consumer report" that directly and adversely affects you, you will be provided with a copy of the "consumer report" before the decision is finalized. You also may contact the Federal Trade Commission about your rights under the FCRA as a "consumer" with regard to "consumer reports", "investigative reports" and "consumer reporting agencies".

I hereby authorize St. Joseph's Center to request an investigative consumer report now and if hired at anytime during my employment, as provided in the Fair Credit Reporting Act. I expressly release and hold harmless each and every person, company or other party that may provide the aforementioned information to St. Joseph's Center.

Submit Your Application
I hereby acknowledge that I have read the above statement and fully understand the terms thereof