• Employment Application Form:

    Thank you for filling out your application. Please note that we will receive your application immediately after submission. There is no need to call us after submission. If we are interested, we will contact you. Please be sure to read the job description of the job before applying.

  • Personal Information:

    Please fill out all information below.
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  • Are You a U.S. Citizen?
  • As of today, Are you at least 18 years old and older?
  • Availability*
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  • Conditions I am willing to work with*
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  • Employment Desired:

    Please fill out all information to the best of your knowledge. We have to contact at least 1 previous employer.

  • Please visit our indeed.com 

    page here to see our open positions.

  • ***Please note, if you applying for the Weekend Coordinator, In-Home Care Floater, or In-Home Care Aid, you will need to complete a competency test upon submission of this application. Be sure to set aside the time to complete this.

    The competency test will take 30-45 minutes to complete*** 

  • What state do you live in or applying for?*
  • Position you are applying for?*
  • Have you lived in Pennsylvania for more than 2 years? [You will need to prove this if your drivers license issue date is less than 2 years as per the PA Regulation 611.52 (a) (d).]
  • Do you understand that as a Floater, you will BE EXPECTED to travel UP TO 60 miles to start services for a client or assist with a call off or no show if needed and you will need to have your own vehicle and reliable transportation. You must also have an open and available schedule. If your answer is no, please pick another position.*
  • Do you understand that as a Marketer, you will BE EXPECTED to be out of the office 95% of the time promoting the business from place to place such as hospitals and other senior homes. You will also need to be very organized and have reliable transportation. If your answer is no, please pick another position.*
  • Do you understand that as an Weekend Coordinator, you will BE EXPECTED to take calls, do surprise home visits, and solve problems when the office is closed during the Weekends from 5pm Friday to 9am Monday morning and on Holidays?*
  • Do you have your PA police check clearance certificate? Do not complete the volunteer version unless you plan to volunteer.(https://epatch.state.pa.us/Home.jsp)*
  • Do you have your PA Physical WITH COMPLETED 2 step TB Test?*
  • Do you have your PA Child Abuse Check Completed? (https://www.compass.state.pa.us/maintenance/pages/)*
  • Do you have you PA Fingerprint clearance certificate?*
  • Do you have your Arizona Central Registry Clearance check?*
  • Do you have Your Arizona Article 9 Fingerprint Card?*
  • Do you have your Arizona Prevention and Support Certificate?*
  • Do you have your First Aid/CPR Training card?*
  • Do you have your 39 month Arizona Driving Abstract Completed? (https://servicearizona.com/motorVehicleRecord)*
  • For Arizona, Do you have any additional trainings valid and completed?*

  • As of today, do you have your own RELIABLE transportation? (A vehicle that can get to back and forth to work?)*
  • If you do not have your own vehicle, Do you live on a bus line or have or reliable means to get yourself to and from work on your own without any issues? (If you answered no to this question, please do not continue the application.)*
  • Do you understand that you can NOT start nor be put on the schedule until you have your clearances completed? (Police Check, Child Abuse, Physical WITH COMPLETED 2 step TB and necessary trainings?) It is fully YOUR RESPONSIBILITY to complete your clearances and trainings. If you have answered no to this question, please do not continue the application*
  • Date You Can Start*
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  • Have You Worked Here Before?*
  • Do you fully understand and acknowledge that a client/consumer/patient/person receiving services in any group setting is NEVER to be left alone unless otherwise stated in their ISP/IEP plan? If your answer is no, please DO NOT continue the application.*

  • Education:

    Please fill out all information to the best of your knowledge. We will verify all information.
  • Graduated?*

  • Graduated?

  • Graduated?

  • Skills/Qualifications:

    This section is for any addition skill or qualification you would like to tell us about. This section is optional.

  • Current Employment:

    Please fill out all information to the best of your knowledge. We have to contact at least 1 previous employer but verify all previous employment.
  • Start Date*
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  • End Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • May We Contact?*

  • Previous Employment:

  • Start Date
     - -
  • End Date
     - -
  • Start Date
     - -
  • End Date
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  • Professional References:

    Please only list references that are previous supervisors or Human Resource Managers. You are allowed one personal reference. You will put your references here but if you move on to the next module, you will be required to do 3 references letters online. Please make sure the reference information is not only valid but the numbers and addresses are updated.

  • Cover Letter & Resume (Optional):

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  • Upload a File
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  • Send Application:

    Please make sure all the information is truthful and correct. You can send your resume if you choose but your resume can not be a replacement for your application.

  • By clicking the submit button below, I certify that all of the information provided by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.  

    In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.  

    I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.  By signing below, you are giving Empress Home Care permission to run your background check and verify all the information above.

    Please note, based on your answers, you will be prompted to take the competency test. If you do not see the competency test, you were not chosen to move forward in the process.

     

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