Landis Homes - Employment Application

Employment Application

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To submit an on-line application, please complete the form below.

If you would prefer to print an application, click the download link below for our Adobe Acrobat application and mail the completed application to the Human Resources Office: 1001 East Oregon Road, Lititz, PA 17543. If you need the Adobe Acrobat PDF viewer, click on the Adobe Acrobat link below to download the free viewer from Adobe.

Download Application below
download (50 KB)

ON-LINE APPLICATION

* Fields identified with an asterisk are required.

PERSONAL INFORMATION

* Last Name:

* First Name:

Middle Name or Initial:

* Street Address:

Street Address 2:

* City:

* State:

* Zip Code:

* Phone Number:

Cell Phone:

Email Address:

Where did you learn of this opening?

* Have you been a Pennsylvania resident for at least the last two consecutive years?

If no, when did you move to Pennsylvania? Month & Year:

EMPLOYMENT INFORMATION

* Position(s) Applying For (Please limit to two positions):

Date Available:

Salary Desired:

Hours Desired (Check all that apply):

Full Time

Part Time

Per Diem/Occasional

Other

If other or you have a preference, please explain:

Shift Availability (check all that apply)

Day

Evening

Night

Weekends Only

Other

If other or you have a preference, please explain:

* Are you employed now?

May we contact your present employer?

* Have you ever filed an application with us before?

If Yes, give date:

* Have you ever been dismissed from employment due to abuse of clients or residents?

If Yes, please explain:

* Have you ever been convicted of a crime involving abuse, fraud, any felony, or any misdemeanor involving theft?

If Yes, please explain:

EDUCATION INFORMATION

Elementary School

Name of School:

City, State or Country (if outside US):

High School

Name of School:

City, State or Country (if outside US):

Number of Years Attended:

Did you graduate?

College

Name of School:

City, State or Country (if outside US):

Course of Study:

Number of Years Attended:

Did you graduate?

Trade, Business, Correspondence School

Name of School:

City, State or Country (if outside US):

Course of Study:

Number of Years Attended:

Did you graduate?

EMPLOYMENT EXPERIENCE (Start with your present or most recent job)

Most Recent Job

From:

To:

Name, Address and Phone of Employer:

Supervisor's Name:

Your Job Title:

Salary:

Reason For Leaving:

Prior Job

From:

To:

Name, Address, and Phone of Employer:

Supervisor's Name:

Your Job Title:

Salary:

Reason for Leaving:

Prior Job

From:

To:

Name, Address, and Phone of Employer:

Supervisor's Name:

Your Job Title:

Salary:

Reason for Leaving:

Prior Job

From:

To:

Name, Address, and Phone of Employer:

Supervisor's Name:

Your Job Title:

Salary:

Reason For Leaving:

OTHER TRAINING/EXPERIENCES

Describe any specialized training, apprenticeship, skills and extra-curricular activities. Summarize special job-related skills and qualifications acquired from employment or other experience:

REFERENCES
Give the names of three persons not related to you whom you have known at least one year.

Reference 1

Name:

Address:

Phone Number:

Occupation:

Years Acquainted:

Reference 2

Name:

Address:

Phone:

Occupation:

Years Acquainted:

Reference 3

Name:

Address:

Phone Number:

Occupation:

Years Acquainted:

APPLICANT'S STATEMENT (Read carefully before signing/agreeing.)
The facts set forth in my application are true and complete. I understand that false statements on this application may be considered cause for rejection of this application or for termination of employment. I hereby authorize Landis Homes to investigate all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between Landis Homes and myself for either employment or for providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise is binding upon Landis Homes. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and that Landis Homes retains a similar right.

If offered employment at Landis Homes, I consent to taking a pre-employment physical examination, drug screen, and tuberculosis skin test or x-ray as required by the PA Department of Health, and authorize Landis Homes to complete a Criminal Background Check in regard to the Older Adults Protective Services Act.

By my electronic signature below, I certify that I was never dismissed from employment due to abuse of clients or residents and have no history or conviction of violent crime.

If you can not certify to any of the above, please explain:

* Electronic Signature (Type your full name to indicate agreement):

* Date: