UCP of NEPA Job Application

Application for Employment

Please complete the form below to apply for a position with us.
United Cerebral Palsy of Northeastern Pennsylvania is an Equal Opportunity Employer that recruits and hires qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.
Personal Information
Full Name

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email Address
Have you lived in Pennsylvania for at least two years?

Education

Please include your high school or equivalency education information as well as any post high school education information.
Please list any other training or skills.

Working with United Cerebral Palsy of Northeastern Pennsylvania (UCP of NEPA)
Position Desired
Available Start Date

MonthDayYear
Salary Desired
Please specify as hourly rate or annual salary.
Are you available to work overtime?
All positions at UCP of NEPA require driving. Do you have a valid driver's license?
How did you hear about this position with UCP of NEPA?
If you were referred by a family member/friend or a UCP of NEPA employee, please list their name below.
Have you ever applied for employment at UCP of NEPA?
Current Employment Status
Are you currently employed?
If you are currently employed, may we contact your present employer?

Employment History

Please list your past employers starting with your most recent employer.
Have you ever been convicted of a crime, including misdemeanors and summary offenses, which have not been annulled, expunged, or sealed by a court?
If yes, please describe in full.

References

Please list three people who are not related to you that we may contact as references.
Reference 1
Reference 2
Reference 3
Waivers
I give my permission for the people listed in the reference section to be contacted by this agency as references for employment. Please initial here*
The information provided in this application is true, correct and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal. Please initial here*
I understand that acceptance of any offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. In Pennsylvania, employment is at-will and may be terminated by employer or employee at any time with or without cause. Please initial here*
Signature
Please sign your name here.*

Date

Resume and Cover Letter

Please upload your resume and cover letter. Please note this step is not required, but we would happily accept these documents.
Upload Your Resume

Cancelof
Cover Letter

Voluntary Self-Identification Form
Completion of this form is completely voluntary. The information is requested to help us comply with federal equal employment opportunity and affirmative action laws. Any information you provide will be kept confidential, stored separately from your application, and will not be used in any hiring decisions.
Gender
Please select an option from the drop-down menu above.
Race/Ethnicity
Please select an option from the drop-down menu above.
Veteran Status
Please select an option from the drop-down menu above.
Disability Status
Please select an option from the drop-down menu above.
Should be Empty:

Application for Employment