JCHAI Application for Employment

APPLICATION FOR EMPLOYMENT
JUDITH CREED HORIZONS FOR ACHIEVING INDEPENDENCE
274 S. Bryn Mawr Avenue, Bryn Mawr, PA 19010
NAME:*

First NameMiddle NameLast Name
CURRENT ADDRESS:*

Street Address

Street Address Line 2

CityState

Zip Code
PHONE NUMBER:*
Format: (000) 000-0000.
EMAIL:*
example@example.com
POSITION DESIRED:*
DATE AVAILABLE TO START:*

MonthDayYear
Date
What is your shift availability? (Weekday daytime, weekday evening, weekend daytime, weekend evening, etc)*
Main Line (based in Bryn Mawr)BuxMont (based in Willow Grove) & Northeast PhillyDoylestown
REFERRED BY: (optional)
YesNo
YesNo
YesNo
YesNo

EDUCATION

Rows	NAME & LOCATION	NUMBER OF YEARS	DID YOU GRADUATE?/ WHAT YEAR?	DIPLOMA/DEGREE
HIGH SCHOOL/GED
COLLEGE
OTHER

EMPLOYMENT (List below your last three employers starting with your current employer.)
Employer Name*
Employer Address*
Start Date*
End Date*
Position*
Name of Immediate Supervisor*
Salary
Reason for Leaving
Employer Name*
Employer Address*
Start Date*
End Date*
Position*
Name of Immediate Supervisor*
Salary
Reason for Leaving
Employer Name*
Employer Address*
Start Date*
End Date*
Position*
Name of Immediate Supervisor*
Salary
Reason for Leaving
REFERENCES

JCHAI will not contact any of your references or current/past employers until we have received your permission to do so later in the application process.

Individuals/employers who know your work ethic. (Include at least one supervisor to whom you reported.)*

Rows	1	2	3
FULL NAME
BUSINESS/ ORGANIZATION
PHONE
EMAIL
RELATIONSHIP
HOW LONG KNOWN?

havehave not
Upload Resume*

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Upload Cover Letter (optional)

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In exchange for the consideration of my job application by JCHAI, 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 for 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 JCHAI practices, shall serve to create an actual or implied contract of employment or to confer any right to remain an employee of JCHAI, or otherwise to change in any respect the employment-at-will relationship between JCHAI and the undersigned, and that relationship cannot be altered except by a written instrument signed by the Executive Director of JCHAI. Both the undersigned and JCHAI may end the employment relationship at any time, without specified notice or reason. If employed, I understand that JCHAI may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.
I also understand that following an initial interview and after any potential conditional offer of employment is made, JCHAI conducts a thorough background investigation, which includes but is not limited to criminal history, Medicare, Medicaid and Department of Health compliance expectations, history of child abuse, medical, physical, drug/alcohol screening and driving records that may be required by JCHAI as a condition of employment.
Any consideration of the criminal background checks conducted will be (1) made consistent with JCHAI's legal obligations pursuant to Pennsylvania statutory regulation regarding providers of services for people with disabilities and limits on whom they may hire; and (2) where such criminal history does not conflict with the requirements of those laws, consideration will be tailored to the requirements of each position.
I further understand that my employment with JCHAI shall be "at-will" and this does not create an employment agreement nor guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause, and with or without notice.
I ACKNOWLEDGE THAT THE INFORMATION PROVIDED IN THIS APPLICATION FOR EMPLOYMENT CONTAINS NO FALSE OR INCOMPLETE INFORMATION. IF IT DOES, BY SIGNING MY NAME, I UNDERSTAND THAT IF I AM EMPLOYED BY JUDITH CREED HORIZONS FOR ACHIEVING INDEPENDENCE, IT IS IMMEDIATE GROUNDS FOR DISMISSAL.
I authorize 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 any previous notice. I hereby give JCHAI permission to contact schools, previous employers (unless otherwise indicated), references and others and hereby release JCHAI from any liability as a result of such contact.
JCHAI is an Equal Opportunity Employer. Applicants for all job openings are welcome and will be considered without regard to race, color, religion, national origin, sex, age, sexual orientation, physical or mental disability, or any other basis protected by state, federal or local law. We assure you that your opportunity for employment with JCHAI depends solely on your qualifications. It is the intent of JCHAI to comply with all applicable federal, state, and local legislation concerning equal opportunity in employment.
Electronic Signature (Full Name)
By typing your full name above, you acknowledge that you have read and understand the terms of this application.
Date*

MonthDayYear
Date
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Should be Empty:

APPLICATION FOR EMPLOYMENT

EMPLOYMENT (List below your last three employers starting with your current employer.)

REFERENCES