1382 Newtown-Langhorne Road
Newtown, PA 18940-2401
(215) 968-9110 FAX: (215) 504-6885

Employment
Application

 

Pennswood Village is an Equal Opportunity Employer. Applicants are considered for all positions without regard to race, color, religion, national origin, sex, age, disability, veteran status, sexual preference or orientation; or the presence of a non-job related medical condition or disability. No question on this application is intended to secure information to be used for such discrimination.

All applications are required, by law, to complete a form requesting a Criminal Records Check or submit a criminal history report with the application. Conviction of one or more of the crimes listed in the Older Adult Protective Services Act will result in a denial/termination of employment. Pennswood Village is a drug-free workplace and employment is contingent on the results of a pre-employment drug test.
       
             
     
   
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Shift preferred:








(i.e., Driver’s License, Social Security Card, Passport, other)


Date(s)
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List any friends and relatives that are or have been employed by Pennswood Village:








TYPE OF SCHOOL NAME AND LOCATION OF SCHOOL
(CITY & STATE)		 COURSE OF STUDY DEGREES LAST YEAR COMPLETED
HIGH SCHOOL GRADUATE?
COLLEGE GRADUATE?
TRADE OR BUSINESS SCHOOL GRADUATE?
PROFESSIONAL LICENSE OR CERTIFICATE LICENSE #
DESCRIBE ANY OTHER RELEVANT TRAINING OR EXPERIENCE:
 

Employment References

Please list three employment references (current and Past employers)











        
     

Military Service Record

Military Employment References

Please list three employment references (current and Past employers)



If you have served in the U.S. Armed Forces, what branch?
Type of Discharge
NAME COMPANY TITLE PHONE NUMBER

 

Applicant Statement


I hereby authorize persons, schools, my current employer (if applicable) and previous employers and organizations named in this application, except where noted, (and accompanying resume, if any) to provide Pennswood Village with any relevant information regarding an employment decision, and I release all such persons from any liability regarding the provision or use of such information.

I understand that my employment is at will, and that either party is free to terminate the employment relationship at any time without cause. I understand that any omission or information provided by me that is found to be false, incomplete, or misrepresented in any respect will be sufficient cause to either cancel further consideration of this application, or immediately discharge me from the employer's service whenever it is discovered.

If employed, I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.