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Employment

Certified Responsive Compassionate

For your convenience, we added our application to our site so you can fill it out and submit it to our HR department directly. After submission please allow three business days for our HR team to review your application, and start the required background checks. We will be in contact thereafter or you can always contact us if you have questions!

First name

Last name

Phone

Email

Address

Birthday

Social Security Number

Are you a citizen of the United States? *

Yes

No

If no, are you authorized to work in the U.S.A.?

Yes

No

What is your birth sex/gender: *

Male

Female

Other

Have you ever been convicted of a felony? *

Yes

No

Have you ever worked for this company? *

Yes

No

Have you been arrested in the last 12 months? *

Yes

No

If yes, please explain:

If yes, when?

If yes, please explain:

What date are you availble to start work?

Position you are applying for? (most applicants should enter "Hab Aid")

Your desired salary or hourly rate:

Education Information:

Did you graduate High School? *

Yes

No

If no, did you compete your GED: *

Yes

No

Question does not apply to me

Did you continue education beyong High School: *

Yes

No

High School Name, address, degree of education, and year graduated:

College Name, address, degree of education, and year graduated:

Please list any other cerifications you may have:

References Information:

Please list three professional or personal references and their information:

Reference #1 Full Name (R1):

Phone (R1):

Type of reference (R1): *

Professional

Personal

Company they work for (R1):

Reference #2 Full Name (R2):

Phone (R2):

Type of reference (R2): *

Professional

Personal

Company they work for (R2):

Reference #3 Full Name (R3):

Phone (R3):

Type of reference (R3): *

Professional

Personal

Company they work for (R3):

Military Service:

If you served in the armed forces please list that information below:

Did you serve in the miliatry? *

Yes

No

Are you currently enlisted in the armed forces/miliatry? *

Yes

No

If you served in the armed forces/military, pleae list what branch and what years you served:

Type of discharge:

Honorable discharge

Medical discharge

Dishonorable discharge

Other (please describe)

If you selected "Other" please describe the type of discharge, nature of discharge and cause of your discharge:

Job History:

Please list your three most recent jobs, which can include your current employement:

Current/most recent job (J1):

Phone (J1):

Address (J1)::

Name of direct supervisor (J1):

Job title/positition (J1):

Second most recent job (J2):

Phone (J2):

Address (J2):

Name of direct supervisor (J2):

Job title/positition (J2):

Third most recent job (J3):

Phone (J3):

Address (J3):

Name of direct supervisor (J3):

Job title/positition (J3):

May we contact your employeer/supervisor (J1): *

Yes, you may

No, please do not

May we contact your employeer/supervisor (J2): *

Yes, you may

No, please do not

May we contact your employeer/supervisor (J3): *

Yes, you may

No, please do not

Reason for leaving (J1):

Start and end dates with company (J1):

Ending salary or hourly rate (J1):

Reason for leaving (J2):

Start and end dates with company (J2):

Ending salary or hourly rate (J2):

Reason for leaving (J3):

Start and end dates with company (J3):

Ending salary or hourly rate (J3):

Disclaimers, acknowledgements, signature:

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Your Signature

By clicking "I agree" I hereby authorize Blessings HCBSP to conduct PA Background Investigations and Drug Testing (as deemed necessary) to retain my employment.

Please select: *

I agree

I do NOT agree

Thanks for submitting!

Background check and clearance form:

Due to State regulations, we are unable to provide the background clearance form online like our application. Therefore, please click the PDF link, download the form, fill it out, sign it, and send it back to us. You can electronically scan it to email the form to our HR department or you can always mail it by post.

For the mailing address please contact our HR department to establish communication: HR@bhcbsp.org

Application

Meet our team by clicking here!

Elderly People Chatting Together

What is HCBS?

Here is some of what we do, and the people we love!

Video link source: https://www.youtube.com/watch?v=CLgJkLsRzzA

Blessings HCBS Provider

412-522-0528

| Certified | Responsive | Compassionate | Care |

© 2023 by Blessings HCBS Provider, LLC

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