Desire Care Services Inc. — Choice, Support, and Independence
302-304-3115 Apply Now

Employment Application

Applying for: Select a position below

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    01Personal Information

    Name

    Address

    02Position & Availability

    Can you work nights and weekends?
    Employment Desired

    Times available each day (i.e. 7am - 5pm):

    03Clearance

    Have you lived outside the state of Pennsylvania in the last two years?

    04Education

    Education - High School

    Education - College / University

    BUSINESS / TRADE SCHOOL

    PROFESSIONAL SCHOOL

    05Work Experience

    Please list your work experience beginning with your most recent job held. If you were self-employed, list the company name. Attach additional sheets if necessary.

    Recent Employment #1

    May we contact?

    List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. Please describe your duties below. Do not leave blank. MUST LIST DUTIES, DO NOT WRITE “SEE RESUME”.

    RECENT EMPLOYMENT #2

    May we contact?

    List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. Please describe your duties below. Do not leave blank. MUST LIST DUTIES, DO NOT WRITE “SEE RESUME”.

    RECENT EMPLOYMENT #3

    May we contact?

    List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. Please describe your duties below. Do not leave blank. MUST LIST DUTIES, DO NOT WRITE “SEE RESUME”.

    06History & Referral

    Have you ever been employed by Desire Care?
    Is any family member or significant other employed by Desire Care?
    How did you hear about Desire Care? Check all that apply:

    07References

    Please list two professional references who have served you in a supervisory capacity. I hereby give permission for Desire Care to contact my professional references listed.

    Supervisor #1

    Supervisor #2

    08Summary & Certification

    An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Please use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

    Did you complete the application yourself?

    I have carefully read the application statement and have provided accurate information. The facts set forth in the application are true and complete. Permission is given to Desire Care Services, Inc. (Desire Care) to verify all information I have provided in this application. I authorize all persons or entities I have referred to in this application to provide any relevant information to Desire Care or its agents for use in any investigations and hereby release them from any liability in doing so.

    I understand and agree that any omission or misrepresentation of facts in my application will be justification for refusal or termination of employment. I understand that this employment application and any other Desire Care documents or statements are not contracts of employment. Employment is contingent upon satisfactory completion of employment requirements and reference checks. I understand that the results of my criminal record check and child abuse history clearance may be used to deny or terminate my employment. A minimum of two professional reference checks are required for employment, one of which must be from the applicant’s current supervisor.

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