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.
Note: Bold items are required.
||Number of years at current address
How did you learn about this position?
What type of employment do you want?
||Are you willing to work weekends?
||Are you willing to work holidays?
||Are you legally authorized to work in the United States
||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
||Have you ever been employed by St. Joseph's Center?
If yes, date: position:
||Have you ever been known by a different name?
||Can you perform the essential functions of the job for which
you are applying with or without reasonable accommodations?
||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
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.|
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
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:
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.
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
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.
I hereby acknowledge that I have read the above statement and fully understand the terms thereof|