Employment Application Apply for employment Thank you for your interest in being a part of the Unlimited Care Family! Below you will find our employment application. Step 1 of 6 16% Applicant Name* First Last PLEASE READ BEFORE COMPLETING OUR APPLICATIONThere is no guarantee of a job offer or a job interview in completing our application. Your application will be considered with others who have submitted applications and decisions about interviews will be based on this comparison. Our application must be completely filled out in order for it to be considered for employment. If the information provided on our application cannot be satisfactorily verified by employment reference checks your application could be considered as incomplete. Please be specific as possible in stating the job applying for: ANY positon is not an acceptable response on our application and will delay the process 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 unless specified by law. In completing our application, you may be subject to the following checks: Employment Reference CheckCriminal Background CheckPennsylvania Child Abuse History ClearanceFBI Finger Print CheckPhysical ExaminationMedical Assistance FraudDriving RecordTwo Step TB TestDrug Screen AUCP is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status. I have read and acknowledge the above statements and will sign below: I agree to all terms* Yes, I agree to all terms. No, I do not agree to all terms. Date of Application* MM slash DD slash YYYY Position Applying For* Direct Care Worker (DCW) Our Direct Care Worker is scheduled within the staff member’s availability and per our participant’s needs. Direct Care Workers make a difference in our community by providing assistance with bathing, dressing, meal prep and errands to individuals with a disability and the aging in the participant’s own home. Residential Program Worker (RPW) - Cambria County Our Residential Program Worker works a full 7.5 hour shift providing assistance with bathing, dressing, meal prep and medication administration to individuals with an intellectual and/ or physical disability in a group home setting. Direct Support Professional (DSP) Direct Support Professionals (DSPs) play a crucial role in fulfilling the mission of Unlimited Care by helping with daily activities such as preparing meals, administering medication if needed, and providing transportation to community activities in order to promote independence. To be successful in this role, you must be compassionate, motivated to help others, and dedicated to providing quality support. Regional Care Specialist Our Regional Care Specialists (RCS) work a 7.5 hour shift daily and report directly to our JARI Drive office. RCSs are experienced caregivers who are adaptable to all situations. They make a difference in our community by providing assistance with bathing, dressing, meal prep, light housekeeping, companionship and community integration services to individuals with a disability and the aging in the participant’s own home. RCSs provide backup services for staff call offs and employee leaves. Caregiver - Allegheny, Beaver, Butler, Lawrence, and Mercer Counties. The Caregiver is responsible for providing in-home personal care with daily living tasks that are outlined in the Individual Service Plan, which is customized to every client. This role provides compassionate care and assistance to individuals in need of in home personal, non-medical care; including: meal prep, light housekeeping, hygiene needs, medication reminders, and more. Van Driver Our weekday, part-time drivers are raved about and are great at working as a team to ensure individuals get to and from personal or central loading areas to social programs, training locations, job sites, or other destinations per assigned schedule. Drivers are trained to fully operate handicap accessible vans and buses, properly secure and stabilize wheelchairs before trips, and on basic vehicle maintenance; including fuel, lubricants, and accessories. Drivers like to hear about their passengers' day and, if they're lucky, get to hear some pretty great jokes. No CDL required. Other Fingerprint Administrator, HR Generalist, Activity Specialist, etc. Direct Care Worker (DCW) Residential Program Worker (RPW) - Cambria County Direct Support Professional (DSP) Regional Care Specialist Caregiver Van Driver Other Location Other*Please type the name of the position you are applying for. Applicant Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code County* Phone*Email* Educational BackgroundEducation Level* Highschool College Graduate School Business/Trade/Other HIGH SCHOOLHigh School Name* High School Address* High School Major Subject* High School Grade Completed*Select Grade Completed9101112High School Degree* HSD GED NONE COLLEGECollege Name* College Address* College Major Subject* College Years Attended*Select Years Attended12345College Degree*If you did not receive a degree then type NONE GRADUATE SCHOOLGraduate School Name* Graduate School Address* Graduate School Major Subject* Graduate School Years Attended*Select Years Attended12345Graduate School Degree*If you did not receive a degree then type NONE BUSINESS/TRADE/OTHEROther School Name* Othe School Address* Othe School Major Subject* Othe School Years Attended*Select Years Attended12345Othe School Degree*If you did not receive a degree then type NONE KEY SKILLSKey Skills*What is the largest person you can manage, in pounds?Key Skills*How many hours, would you prefer, weekly?Key Skills*Please list all the languages you speak fluently. How Did Your Hear About Us?*Please check any and all that apply. Print Advertisement/Newspaper Radio Ad Employment Agency Walk‐In Job Fair Website Television Commercial Conemaugh Hospital TV Facebook/Twitter/Instagram Flyer Did an employee refer you?* YES NO Please list the employee that referred you.* EMPLOYMENT HISTORYPrevious Employment*Please list, at least, your most recent employer. Applicants are encouraged to list up to three (3) companies. 1 2 3 Company OneCompany Name* Phone*Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Supervisor*Name of your supervisor Supervisor Contact*May we contact your supervisor for a reference? YES NO Date Started* MM slash DD slash YYYY Date Left* MM slash DD slash YYYY Company TwoCompany Name PhoneAddress Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code SupervisorName and Title of your supervisor Supervisor ContactMay we contact your supervisor for a reference? YES NO Date Started MM slash DD slash YYYY Date Left MM slash DD slash YYYY Company ThreeCompany Name PhoneAddress Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code SupervisorName and Title of your supervisor Supervisor ContactMay we contact your supervisor for a reference? YES NO Date Started MM slash DD slash YYYY Date Left MM slash DD slash YYYY It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without case and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary. I understand that references will be contacted, and that appropriate work related references are not limited to those listed on my application. I authorize Alleghenies Unlimited Care Providers and its affiliates to contact and secure information about my educational background, work experience, credit rating and to secure records of licensing, administrative, regulatory or any other governmental agency, and to contact any other information sources relevant to employability. I hereby release Alleghenies Unlimited Care Providers and its subsidiaries, officers and agents from liability for seeking information, and all other persons, schools, corporations or organizations for furnishing such information. I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.In processing this employment application, we may request that an investigative consumer report be prepared, which may include information as to your employment, finances and general reputation. If so, you will receive a separate authorization form, in addition to this application.I understand and agree that drug screening test is a condition of application for employment, and may be done prior to employment. I understand that positive results may be grounds for refusal to hire. I also understand and agree that the company reserves the right to require me to submit to a drug and alcohol screening test at any time after employment. The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law. This application is current for only 60 days. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary to fill out a new application. Submission Date* MM slash DD slash YYYY I understand and give permission* Yes, I understand and give permission. No, I do not understand nor give permission. You understand and give permission to process the application as stated in the terms..NameThis field is for validation purposes and should be left unchanged.
