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Minimum Requirements for Employment through Evergreen Homes Inc.

Must be at least 18 years of age
Must have valid PA driver's license in good standing
Current Physical and Mantoux TB Test
Criminal Background Check
High School Diploma or equivalent

Personal Information

Last Name *

First Name *

MI: *

Street Address: *

City, State, & Zip *

County *

Contact Number: *

Are you a U.S. Citizen? *

Yes

Social Security #: (SSN is not required to fill out an application, however this information will be required before going through the hiring process)

Do you reside in Pennsylvania? *

Yes

If yes, how long?

Are your records listed under another name? *

Yes

If yes, list name:

This could include maiden names or nicknames

Do you have a PA Driver's License? *

Yes

(Required for employment)

Please list driver's license number & expiration date: *

Do you have a current CPR or First Aid card? *

Yes

Do you have previous experience working with people with disabilities? *

Yes

Explain:

Education

High School: *

Dates Attended: *

Graduation Date: *

College or University: *

Dates Attended: *

Major/Minor: *

Graduation Date: *

Type of Degree/Credits Earned: *

Other Schooling/Certifications:

Employment History

(Please list the last three places of employment)

Employer's Name:

Address:

Phone:

Position Held/Hours Per Week:

Supervisor's Name/Title

Dates of Employment:

Description of Duties:

Employer's Name:

Address:

Phone:

Position Held/Hours Per Week:

Supervisor's Name/Title

Dates of Employment:

Description of Duties:

Employer's Name:

Address:

Phone:

Position Held/Hours Per Week:

Supervisor's Name/Title

Dates of Employment:

Description of Duties:

Were you ever convicted of a criminal offense or have you ever forfeited bond or collateral in connection with a criminal charge? *

Yes

(The term criminal offense is defined as any felony or misdemeanor, including any summary offense. Omit only minor traffic violations and any offenses committed before your 18th birthday.)

If yes, please describe:

Are there any criminal charges pending against you? *

Yes

If yes, please describe:

NOTICE: Answer the criminal activity questions honestly. The agency requires a criminal background check upon hire. Failure to answer honestly will result in immediate termination.

Evergreen Homes requires that all employs, upon hire, complete a criminal clearance. The agency will accept clearance dated no more than 1 year prior to date of hire. This is completed at the cost of the employee and each clearance is $22.00. Applicants who have not resided in the state of Pennsylvania within the last 2 years are also required to complete an FBI Background Check at the applicant's expense. In addition, the applicant will be screened through the federal data base system, upon hire and monthly thereafter, for exclusion of receiving federal money due to fraud as required by the Department of Public Welfare.

All new employees will be required to have a physical with a Mantoux TB test prior to their first day of work. This is at the expense of the employee.

All applicants will be required to have a motor vehicle report check on their driving record. This is done during the interview. If an applicant's driving record is not satisfactory, they will not be hired. This is completed at the cost of the applicant. The fee is $10.00.

According to PA State Regulations, Evergreen Homes cannot employ any person under the age of 18 or anyone who has been convicted with a felony.

***By submitting this online application for employment I hereby certify that all statements are complete and correct to the best of my knowledge and belief. I am aware that all statements contained herein will be verified and that willful misrepresentation will result in termination.***

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Minimum Requirements for Employment through Evergreen Homes Inc.

Personal Information