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Home
Contact
Make a Payment
Donate
Pay It Forward
Newsletter
Our Senior Centers
Kingwood
Newburg
North Preston
Rowlesburg
Terra Alta
Tunnelton
Valley District
In-Home Services
Services
Medicaid Waiver
Personal Care
Private Pay Program
Case Management
Veterans Program
Respite Program
Alzheimer’s/Dementia Program
Lighthouse Program
Staff
Payment Options
Careers
Contact In-Home Services
Nutrition
Menu
Nutrition Transportation
Why Nutrition is Important
Do I Qualify for Home Delivery?
Why It Is Important to Eat with Us
Transportation
Services
SHIP Counseling
Senior Employment Program
Medical Equipment Loan Closet
Medical Escort
Health Screenings
Low Income Energy Assistance
Farmers Market Coupons
Activities
At the Centers
Community Shopping
Trips and Events
Senior Clubs
Preston County Picnics
Exercises
Assist Us
Volunteer
Teach a Class
Fundraiser
Donate
Pay It Forward
About
Mission and Funding Statement
Advocacy
Staff
Newsletter
Updates
WV Senior Needs Survey
PCSC Careers
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Employment Application
Step
1
of
3
33%
PRESTON COUNTY SENIOR CITIZENS, INC.
PLEASE READ THE FOLLOWING BEFORE COMPLETING OUR APPLICATION BLANK:
1. There is no guarantee of a job offer or a job interview in completing our application blank. Your application blank will be considered with others who have submitted applications and decisions about interviews will be based on this comparison.
2. Our application blank must be completely filled out in order for it to be considered for employment.
3. If the information provided on our application cannot be satisfactorily verified by employment reference checks your application could be considered as incomplete.
4. Applications are filed according to job title. Be as specific as possible in stating the job applying for: ANY position is not an acceptable response on our application blank.
5. Due to the large number of applications we receive and the competitive nature of our employment process specific reasons for employment decisions will not be released.
6. In completing our application blank you will be subject to the following checks:
EMPLOYMENT REFERENCE CHECK FROM FORMER EMPLOYERS
CRIMINAL RECORD CHECK
DRUG SCREEN
I have read the above statements. Name of Applicant:
*
First
Last
Applicant Information:
Name
*
First
Middle
Last
Date
*
Month
Day
Year
Social Security Number:
*
Phone
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
*
Position & Availability:
Position Applied for:
*
Date Available:
*
Employment Availability:
*
Full Time
Part Time
Temporary
PRN
Days / Hours Available:
*
Eligibility
Legally authorized to work in the United States?
*
Yes
No
Are you at least 18 years of age?
*
Yes
No
Previously employed by this organization?
*
Yes
No
If yes, dates / position:
Education
High School / GED
Name
City / State
Diploma / Degree
Graduation Year
College / Technical School
Name
City / State
Degree / Certification
Graduation Year
Employment History (Most Recent)
Employer 1
Employer Name
Phone
Job Title
Dates of Employment
Reason for Leaving
Employer 2
Employer Name
Phone
Job Title
Dates of Employment
Reason for Leaving
Employer 3
Employer Name
Phone
Job Title
Dates of Employment
Reason for Leaving
Use this section if you need additional space and please account for all periods of unemployment:
References
Reference 1
*
Name
Relationship
Phone Number
Reference 2
*
Name
Relationship
Phone Number
Reference 3
*
Name
Relationship
Phone Number
Driving Information (if applicable)
Do you have a valid driver's license?
Yes
No
License
State
Number
Expiration Date
Can you provide proof of insurance if required?
Yes
No
Skills & Certifications
Relevant training, skills, licenses and certifications
*
APPLICANT STATEMENT & AUTHORIZATION
I certify that the information I have provided in this application is true and complete to the best of my knowledge. I understand that false or misleading information may result in disqualification from consideration or, if hired, termination of employment.
I authorize the organization to verify information regarding my employment, education, references and qualifications as permitted by law. I understand that employment, if offered, is at will, meaning either I or the organization may end the employment relationship at any time, with or without notice or cause, subject to applicable law.
Any separate background check or consumer report authorization will be provided as required.
Applicant Signature
*
First
Last
Date
*
Δ
