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Peter Becker Community New Online Application
APPLICATION FOR EMPLOYMENT
Peter Becker Community is an Equal Opportunity Employer committed to providing its employees reasonable accommodations in accordance with those guidelines established by the Americans with Disabilities Act.
First Name (*)
Please enter your first name.
Middle Name/Initial
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Last Name (*)
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Address 1 (*)
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City (*)
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State (*)
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Zip (*)
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Phone Number (*)
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Cell Phone Number
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Social Security Number (*)
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E-mail Address (*)
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What is the best way to contact you?
Email
Home Phone
Cell Phone
Letter
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When is a good time to contact you?
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Are You A U.S. Citizen? (*)
Yes
No
This is a required field. Select Yes or No.
Have you ever been dismissed from employment due to abuse of clients or residents? (*)
Yes
No
This is a required field.
Do you have a history of or conviction for violent crime? (*)
Yes
No
This is a required field.
Interest
Activities
Administration
Accounting
Dining Services
Housekeeping
Human Resources
Nursing
Plant Operations
Social Services
Nurse Aid Certification Class
Unknown
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Would You Work:
Full Time
Part Time
Pool
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Upload Your Resume
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Shift Preference (*)
7 am - 3:30pm
3 pm - 11:30pm
11 pm - 7:30am (Nursing only)
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What promted you to apply?
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Were you referred by a current employee?
Yes
No
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Name of Referring Employee
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EMPLOYMENT HISTORY
Peter Becker Community Reserves the right to contact employers listed unless otherwise indicated.
If granted an interview, we will require information about past employers.
Previous Employer (*)
Please enter your employer name.
Previous Employer Address
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Position Held (*)
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Dates: From - To (*)
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Salary
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Supervisor's Name & Phone (*)
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May we contact this employer? (*)
Yes
No
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Reason for Leaving (*)
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EDUCATION
Please list Name & Location of Schools and Colleges Attended, Major Subject, Did you Graduate? & Degree or Diploma Earned
Formal Education Listing
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PROFESSIONAL REFERENCES
Please list your references:
Provide Name, Occupation, Address, Phone, & Years Known for each listing.
Professional References
Peter Becker Community
800 Maple Avenue
Harleysville, Pennsylvania 19438
215.256.9501
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