Application for Employment

Pendleton Senior & Family Services, Inc. is an equal opportunity employer and applicants will be considered solely on the basis of individual qualifications and merit without regard to race, creed, color, religion, sex, age, national origin, economic level or the presence of non-job related medical condition or handicap.

This application will be retained for 6 months from the date of the application.

Please Complete All Information On This Application

Address:
Are you presently employed?
Are you a citizen of the United States?
If hired, could you give written evidence of a right to work in this country?
Are you available to work:
Are you on a lay-off and subject to recall?
Several jobs here require the ability to travel. Are you a licensed driver?
Do you have any objection to travel?
Have you ever been convicted of a felony?
Are you a veteran of the U.S. Military service?
Were you referred to this agency for work by one of our employees?

EDUCATION

Do you have a high school diploma or equivalent?

GENERAL INFORMATION

RECORD OF EMPLOYMENT

Address:
Address:
Address:

PERSONAL REFERENCES

Give the names and addresses of three persons, OTHER THAN RELATIVES, who have known you and whom we may contact for recommendations on your behalf. Please complete ALL information requested.
Address:
Address:
Address:

REFERENCE AUTHORIZATION

I hereby authorize Pendleton Senior & Family Services, Inc. (PSFSI) to contact prior employers, individuals I have provided as personal references or others to obtain any and all information related to my past work performance. Also, I authorize PSFSI to contact the Pendleton County Courts for the purpose of obtaining any criminal or unlawful information about me. A photocopy of this authorization shall have the same force and effect as the original.

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