Apply for a Career

Area of Interest

Please choose a field

Please choose a position

Contact / Personal Information

First Name*

Last Name*

Email*

Cell Phone*

Primary Phone*

Alternative Phone*

Please provide the best way to contact you*  Email Phone

Current Address

Street Address*

City*

State*

Zip Code*

How long have you lived at this address*
 Less than 5 years More than 5 years

Is this address your permanent address*  Yes No

How did you hear about us?

How did you learn about Penterman Professional Care*
 Advertisement Internet Employment Agency PPC Employee
Other (specify)

Eligibility

Are you 18 years of age?*  Yes No

If hired, can you provide proof of legal age?*  Yes No

If an employment opportunity is offered you will be asked to show proof of identification, reliable transportation, auto insurance and work references. Will you be able to provide this information?*  Yes No

Education

What is the highest level of education you have achieved?*

High School

Name & Location

Years Attended

Major Field

Degree

College

Name & Location

Years Attended

Major Field

Degree

Graduate

Name & Location

Years Attended

Major Field

Degree

Trade/Business

Name & Location

Years Attended

Major Field

Degree

Communications

Are you fluent in reading, writing or speaking Spanish*  Yes No

Availability

Salary Requirement
Annual Hourly

Are you available to work*
 Full Time Part Time

Are you available to work night shifts*  Yes No

Are you available for travel*  Yes No

Hours Available*

 7a-3p 3p-11p 11p-7a all hours

Days available*

 Sat Sun Mon Tues Wed Thur Fri

Available for weekends or occasional weekends*  Yes No

Current Status

Are you currently employed?*  Yes No

Position currently held?*

Type of Environment*

 Home Facility Office

Other (Describe)

Employment History

Employer*

Position*

Dates*

Supervisor*

Telephone*

Reason for Leaving*

Describe Duties*

Pay Rate*

May we contact your employer?*  Yes No

Employer #2

Employer

Position

Dates

Supervisor

Telephone

Reason for Leaving

Describe Duties

Pay Rate

May we contact your employer?  Yes No

Employer #3

Employer

Position

Dates

Supervisor

Telephone

Reason for Leaving

Describe Duties

Pay Rate

May we contact your employer?  Yes No

Background and Consent

If employment is offered would you be willing to submit to pre-employment drug screening and background check?*  Yes No

References (please do not list relatives)

Name

Address

Phone Number

Occupation

Reference #2

Name

Address

Phone Number

Occupation

Reference #3

Name

Address

Phone Number

Occupation

Additional Comments

Please comment on any other experience, skills or qualifications you have which would be valuable to Penterman Professional Care.