First Light Home Care of Levittown
4800 E Street Road, Suite 158, Feasterville Trevose, PA 19053

APPLICATION FOR EMPLOYMENT

Thank you for your interest in FirstLight Home Care of Levittown. FirstLight Home Care of Levittown is an equal employment opportunity employer. The Company's policy is not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. FirstLight Home Care of Levittown also prohibits harassment of applicants or employees based on any of these protected categories. It is also FirstLight Home Care of Levittown's policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions.

Note to Applicants: Smoking is prohibited in all indoor areas of FirstLight Home Care of Levittown unless designated smoking areas have been established by a particular location in accordance with applicable state and local law.

Name (First, Middle, Last): Phone Number:
Any Alternate Name(s) Used in the Past (e.g., Maiden Name): Current Address (Street, City, State, Zip):
Date of Application: Email:

Availability

Preferred Working Days Weekdays:
Weekends:
Morning shift:
Afternoon:
Evenings:
Overnight stay:
Are you open to working holidays?
Hours Per Week Preference



Do you own a car?     

Note: If hired you will be required to share proof of a valid driver's license and auto insurance.

Are you legally authorized to work in the United States?     

Work history (in case your resume is current, no need to fill this section).

Employer name Job Title & Details (Duties, Responsibilities) Employment Dates (Month/Year)
1.  From:
To:
2.  From:
To:
3.  From:
To:

Caregiving Experience

For the following list of activities of daily living (ADLs) please check all the experiences you have. This information is only for scheduling purposes and will not discount your application in any way.

Reference Authorization

Can we contact your past employer(s) about your employment?     

Please share two references we can call. One reference can be personal (non-relative).

Name Phone Number or email Relationship (if not employer)

THIS APPLICATION IS NOT COMPLETE UNTIL IT IS FULLY COMPLETED, SIGNED, AND
ALL STATEMENTS BELOW HAVE BEEN READ AND INITIALED.

Initial:

I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered.

Initial:

I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or without cause or notice. I understand that only the CEO of FirstLight Home Care of Levittown, and no manager, supervisor, or other representative of the Company, has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the at-will employment relationship, and with respect to any agreement entered into by the CEO, any such agreements must be in writing and signed by the CEO and by me or my authorized representative.

Initial:

I further understand and agree that, except for my at-will employment status, if hired, my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by FirstLight Home Care of Levittown.

Initial:

I understand that the Company may share the information contained in this application with other Company employees for employment and administrative purposes and hereby consent to such transfer.

Initial:

I hereby authorize, to the extent allowed by applicable federal state and local laws, FirstLight Home Care of Levittown to conduct its own investigation of my references, employment history and education and, further, authorize the references and prior employers I have listed to disclose to the Company information related to my employment history and qualifications for the position for which I am applying, without giving me prior notice of such disclosure.

Initial:

I agree to undergo a pre-employment physical examination consistent with federal and state law.

Initial:

I agree to submit to legally permissible drug and alcohol testing upon an offer of employment from FirstLight Home Care of Levittown and prior to starting work. I agree that any offer of employment is contingent upon my receiving a result satisfactory to the Company.

Initial:

I agree to provide evidence of baseline TB test in accordance with state requirements. In case no documentation is available, I agree to undergo TB skin test (TST) or blood test (IGRA) at FirstLight's expense when required or as identified by TB risk assessment.

My signature below certifies that I agree to be bound by the terms and conditions stated in this application, which contains all the understandings between the Company and me concerning the topics addressed herein, and supersedes any prior inconsistent understandings between the Company and me on such issues.

This application will only be considered for 30 days. If you have not been hired within 30 days of submitting this application and you wish to continue to be considered for employment, you must complete another application.