Apply for Personal Care Attendant

Please complete the form below and click Submit to send your application to CKV for consideration. Fields with an asterisk (*) are required.

Summary
Title:Personal Care Attendant
ID:0102
Department:Personal Care
Contact Information
* First Name:
* Middle Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
Email:
Application Information
Source:
Opt-In Confirmation
I authorize recruiters from Cross Keys Village - The Brethren Home Community to send text messages from 8555090536 with requests for additional information in relation to this job application only. Message/data rates apply. Message frequency varies.
Attachments
Resume:
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Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Application for Employment
PERSONAL INFORMATION
* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment):
Yes   No

* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):
Yes   No

* Have you ever been convicted of a felony or a misdemeanor? (No applicant will be denied a position because of a conviction for any offense which is not related to the circumstances of the job(s) sought.):
Yes   No

If Yes, please list all convictions, felonies and/or misdemeanors other than minor traffic violations and include dates, offenses and charges.:

* Have you ever been found guilty or plead guilty to abuse, neglect or mistreatment of a person?:
Yes   No

If yes, please explain:

* Have you ever been excluded or prohibited from being paid with federal programs or money?:
Yes   No
.
If yes, please explain:

* Have you ever worked for Cross Keys Village - The Brethren Home Community before?:
Yes   No

If Yes, please provide details (Where/When/Job Title and indicate other names worked under):

* How did you find out about this position?:
Indeed   Career Builder   Glassdoor   Juju   Facebook   LinkedIn   The Merchandiser   York Community Courier   Billboard/Sign   Agency   Job Fair Referral   Current Team Member Referral   Other

If referred by a current CKV Team Member, please list their name(s) here:

* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?:
Yes   No

If no, please explain:

EMPLOYMENT DESIRED
* When would you be available to begin work?:
* Type of employment desired:
Full-Time
Part Time
Seasonal
On Call
Weekends Only
* Shift desired:
  
  

* Are you currently employed?:
Yes   No
If presently employed, why are you considering leaving?:

EDUCATION AND CERTIFICATION/LICENSE
Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location Did you Graduate? Degree Received Subjects Studied/Major
Yes   No
Yes   No
Yes   No

Please list any certification(s) and/or professional license(s) as they relate to the position in which you are applying.

Type of License/Certificate License/Certificate Number State Expiration Date

If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:

EMPLOYMENT HISTORY
List all employers for the last ten years, most recent first, and indicate other names worked under. If you have more then four employers within the past ten years, you must include that information after "Employer 4"

EMPLOYER 1

Dates Employed Employer Name & Address Employer Phone
From:

To:

Job Title Supervisor Name & Title Hours Worked Per Week

Responsibilities Reason for Leaving Salary/Hourly Rate
Start:

End:

EMPLOYER 2

Dates Employed Employer Name & Address Employer Phone
From:

To:

Job Title Supervisor Name & Title Hours Worked Per Week

Responsibilities Reason for Leaving Salary/Hourly Rate
Start:

End:

EMPLOYER 3

Dates Employed Employer Name & Address Employer Phone
From:

To:

Job Title Supervisor Name & Title Hours Worked Per Week

Responsibilities Reason for Leaving Salary/Hourly Rate
Start:

End:

EMPLOYER 4

Dates Employed Employer Name & Address Employer Phone
From:

To:

Job Title Supervisor Name & Title Hours Worked Per Week

Responsibilities Reason for Leaving Salary/Hourly Rate
Start:

End:

* Have you worked more than the jobs listed above within the last ten years?:
Yes   No
If you have worked more than four jobs within the last ten years, you must include the additional employers here. Make sure to include the Employer Name, Address and Phone Number, Dates Employed, Supervisor Name and Title and your reason for leaving:

REFERENCES Please list three persons who you know well, but do not include relatives. If you have attended high school within the past two years, please list two teachers.

Name Relationship Phone Number Email
*
*
*
*
*
*
*
*
*

AUTHORIZATION
I understand that any falsification or omission of information will be sufficient cause for the disregarding of this application or termination of my employment.

I agree that an investigation may be made and I hereby authorize Cross Keys Village-The Brethren Home Community to contact listed employers and references, verify information and reports for any agency to evaluate my suitability for employment. I also agree to hold Cross Keys Village – The Brethren Home Community harmless from any result of such investigation.

I hereby authorize any former employer, person, firm, corporation, school, and/or governament agency to answer any and all questions and to release or provide any information with their knowldege or reports. I agree to hold any or all of them blameless and free of any liability for releasing any thruthful information that is within their knowledge or record.

I certify that I am of legal age to work in the job that I have applied for, that I am legally permitted to work in the United States of America and if offered employment will provide documents as required by Federal Law.

I understand that the acceptance of this application does not indicate there are any positions available and does not obligate Cross Keys Village-The Brethren Home Community in any way.

If conditionally offered employment, I agree to be subject to an examination by a Physician (M.D. or D.O.) currently licensed to practice in the Commonwealth of Pennsylvania, as required by regulations, or if I am disabled, the essential job functions with reasonable accommodations as necessary. A pre-employment physical, functional screen, and drug test will be required before any applicant begins employment. If all other requirements have been met, any job offer is contigent upon the results of these tests.

I understand and agree that if I am accepted for employment with Cross Keys Village – The Brethren Home Community, either I or Cross Keys Village – The Brethren Home Community may terminate the employment relationship at any time, for any reason, with or without cause or notice.

I hereby authorize my police record to be released to Cross Keys Village - The Brethren Home Community (if applicable). I do hereby release you, as the custodian of such records from any and all liability for damages of whatever kind, which may at any time result to me, because of compliance with this authorization. I further understand that my employment is inpar, contingent on a conviction record which is free of any crime, the circumstances of which substaintially relate to the activities engaged in by Cross Keys Village - The Brethren Home Community.

By submitting my application for employment and clicking submit below, I hereby accept this as my electronic signature which confirms my representation and qualifications for the position(s) applied for above.

* Signature (type name):
* Date:
Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The Information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond

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