Grace Manor at North Park: Senior Assisted Living Residence

e’re looking for great caregivers!

APPLICATION FOR EMPLOYMENT

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability, or union affiliation.

Please review the instructions listed below carefully before filling out this Application. Failure to follow the instructions or failure to fully complete and sign this form will result in the exclusion of your Application.
This Application will be kept on file for 90 days. If you wish to be considered for employment after 90 days from the date you submit your Application, you need to return to the office and fill out another application.
Answer only the questions asked. DO NOT include any extraneous information that would indicate your race, age, color, sex, religion, national origin, disability or union affiliation. Since we are an Equal Opportunity Employer, information relating to those factors has no place in our hiring process.

Personal Data

First Name	Middle Name	Last Name

Address	City	State	Zip

Social Security #:		Best times to contact you:
Work Phone #:		Home Phone #:
		Cell Phone #:

Position Sought:		Salary Requested:
Will you accept full-time work?:	Yes:
Will you accept part-time work?:	Yes:
Will you work all shifts including overtime?:	Yes:
Date Available:		How were you referred to us?:

Are you of legal age to work?:	Yes:
Are you a U.S. citizen or have a legal right to be employed in the U.S.? (If yes, proof is required):	Yes:
Can you perform the essential functions of the job(s) for which you are applying?:	Yes:
Do you have a position with another employer that would continue if employed by us?:	Yes:
If travel is required, do you have any restrictions?:	Yes:
Can you work overtime without prior notice?:	Yes:
Do you have any experience from military service that would be relevant to the job(s) for which you are applying? If Yes, please explain:	Yes:

Have you ever been convicted of a felony or released from prison in the past five years? If Yes, please explain (Note: A yes answer does not automatically disqualify you from employment, since the nature of the offense, date and type of job for which you are applying will be considered):	Yes:

EMPLOYMENT HISTORY (Please list your present or most recent employer first)

May we contact your most recent employer?:

Yes:

Employer:		Phone #:
Address:		Employed (from-to):
Position Title:
Wage/Salary:		Supervisor's Name:
Reason for Leaving:
Nature of work performed and responsibilities:

Employer:		Phone #:
Address:		Employed (from-to):
Position Title:
Wage/Salary:		Supervisor's Name:
Reason for Leaving:
Nature of work performed and responsibilities:

Employer:		Phone #:
Address:		Employed (from-to):
Position Title:
Wage/Salary:		Supervisor's Name:
Reason for Leaving:
Nature of work performed and responsibilities:

Education

School Attended	Name	City, State, Zip	Major/Course of Study	Highest Level Completed	Degree
High School
College
Graduate School
Business/Trade
Other (describe)

APPLICATION FORM WAIVER - PLEASE READ CAREFULLY

In exchange for the consideration of my job application with Grace Manor at North Park (hereinafter called "the Company"), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or confer any right to remain an employee of the Company, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned; and that relationship cannot be altered except by a written instrument signed by the President of the Company.  Both the undersigned and the Company may end the employment relationship at any time, without specified notice or reason.  If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize the investigation of all statements contained in this application.  I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without previous notice.  I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contact.  I agree that the Company or any of its subsidiaries shall not be liable in any respect if my employment is terminated because of falsity of statements, answers, or omissions made by me on this application.

I understand that in connection with the routine processing of my employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics and mode of living.  Upon written request from me, the Company will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.  In addition, if I am required to operate a motor vehicle in the course of my job, the Company is authorized to request a report of my driving record (MVR) and I understand any offer of employment is contingent on an acceptable report.

I further understand that my first ninety (90) days of employment with the Company shall be considered an orientation period, and further that at any time during the orientation period or thereafter, my employment relations with the Company is terminable at will for any reason by either party.  In addition, I understand that no promise, representation or agreement to the foregoing is binding on the Company unless made in writing and signed by me and the President of the Company.

Or you may download, fill out, and send the attached application (PDF) to
Grace Manor at North Park
9565 Babcock Boulevard
Allison Park, PA 15101

Download PDF Application

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