PHSNC Application
It is the policy of Phila Health Systems of NC to provide equal employment opportunities to all applicants and employees withuto regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status Please email completed application and professional resume to hr@phsnc.org for consideration.
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Drivers License Number / State
Availability to Start
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-
Month
-
Day
Year
Date
Emergency Contact
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First Name
Last Name
Relationship
Phone
Desired Position
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Certified Peer Support Specialist
Qualified Professional
Certified Substance Abuse Counselor (CSAC)
Therapist
Administrative Assistance
Other
Are you 18 years old?
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Yes
No
Are you a Certified Peer Support Specialist?
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Yes
No
Are You able to provide proof that you are legally eligible for employment in the United States?
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Yes
No
Previous Employment
*
Previous/Current Employer
Street Address
City
State / Province
Postal / Zip Code
Previous Employment
Previous Employer
Street Address
City
State / Province
Postal / Zip Code
Education
*
High School
Street Address
City
State / Province
Postal / Zip Code
Education
Vocational/ College/ University
Street Address
City
State / Province
Postal / Zip Code
Applicant Certification and Authorization I certify that the information provided in this application is truthful and accurate to the best of my knowledge. I understand that providing false or misleading information may result in the rejection of my application or, if employed, immediate termination of my employment. I authorize Phila Health Systems of NC to contact my previous employers and educational institutions to verify my employment history and academic records. I further authorize my former employers and educational organizations to fully and freely disclose information regarding my previous employment, attendance, and academic performance. Additionally, I grant permission for the individuals designated as references to provide relevant information about my work history and qualifications.If I am offered employment, I understand that, unless a specific written contract is signed by the CEO of Phila Health Systems of NC, my employment will be "at-will." This means that the employment relationship is voluntary for both myself and my employer, and either party may terminate the relationship at any time, with or without cause. I acknowledge that I may resign from my position at my discretion, and my employer reserves the same right to end the employment relationship.Furthermore, I understand that no agent, representative, or employee of Phila Health Systems of NC—except through a specific written contract of employment signed by the CEO—has the authority to alter or modify the at-will nature of my employment.By signing below, I acknowledge that I have read, understand, and agree to the terms outlined in this certification.
Signature
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Date
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-
Month
-
Day
Year
Date
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