Careers Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Application for EmploymentDate *Positions Applying For *Referred ByEmail *Name *FirstLastTelephone Number *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHave you been a resident of Pennsylvania (without interruption) for two years preceding the date of this application? *YesNoHave you ever filed an application with this company before? *YesNoIf filed an application before, when? *Have you ever been employed with this company before? *YesNoIf employed before, when? *Have you ever been terminated or disciplined by a previous employer for abuse or neglect? *YesNoIf terminated or disciplined, which employers and when? *May we contact your present or previous employers? *YesNoAre you prevented from lawfully becoming employed in this country because of a Visa or Immigration Status? *YesNoAre you prevented from lawfully becoming employed in this country because of a Visa or Immigration Status? *YesNoOn what date would you be able to start work? *Do you have a valid driver's license? *YesNoYears of driving experience: *What days and hours are you available to work? * Education High SchoolHigh School City, StateHigh School Course of StudyGraduated?YesUndergraduateUndergraduate City, StateUndergraduate Course of StudyGraduated?YesGraduateGraduate City, StateGraduate Course of StudyGraduated?Yes Employment Experience Employer1 Name *Employer1 Last Position HeldEmployer1 Start DateEmployer1 End DateEmployer1 Supervisor Name & TitleEmployer1 Reason for LeavingEmployer2 NameEmployer2 Last Position HeldEmployer2 Start DateEmployer2 End DateEmployer2 Supervisor Name & TitleEmployer2 Reason for LeavingEmployer3 NameEmployer3 Last Position HeldEmployer3 Start DateEmployer3 End DateEmployer3 Supervisor Name & TitleEmployer3 Reason for LeavingHave you ever had any job-related training in the United States Military? (copy) *YesNoAre you aware of any reason why you cannot perform the duties for this position that you are applying for? *YesNoAre there any other experiences, skills or abilities that you feel will qualify you for work with our company? Certificates & Licenses Certificate1 TypeCertificate1 FieldCertificate1 DateCertificate1 StateCertificate2 TypeCertificate2 FieldCertificate2 DateCertificate2 State Applicant References Reference1 FirstReference1 LastReference1 CompanyReference1 Job TitleReference1 RelationshipReference1 Phone NumberReference2 First NameReference2 Last NameReference2 CompanyReference2 Job TitleReference2 RelationshipReference2 Phone NumberReference3 FirstReference3 LastReference3 CompanyReference3 Job TitleReference3 RelationshipReference3 Phone Number About Me Tell us a little about yourself. (e.g. employment experience, interests, etc.): Applicant Statement Paragraph TextI understand that Quality Progressions affords equal employment opportunity to applicants and employees. Quality Progressions' Affirmative Action Plan ensures all applicants and employees that it will not be discriminatory when judging each applicant as to qualifications for a position and each employee as to performance in a position as regards to race, color, religion, sex, age, national origin or disability. I understand the information on this application is subject to verification by Quality Progressions. I hereby grant permission to Quality Progressions to contact my present or previous employers, unless otherwise indicated; and I further authorize my former employers to give any information as to my character and record, including employment dates, position, and salary. I hereby release Quality Progressions from all liability and damages related to reference inquiries as well as those individuals or companies who provide reference information. I understand that as a condition of employment, I will be required to undergo and successfully pass a screening for alcohol and or drugs; a motor vehicle driving record and criminal/child abuse clearance unless not applicable to the job position for which you applied. I further understand that I will be required by federal law (the Immigration Reform and Control Act of 1986) to produce documents establishing both my identity and work authorization. In the event of employment, I understand that false, incomplete or misleading information given on my application or interview(s) will result in separation of employment. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. I understand, also, that I am required to abide by all rules and regulations of the agency as delineated in the Quality Progressions' Personnel Codes & Practices and other written policies and procedures. I accept the Applicant's Statement *YesNo Applicant Cerification asdf NameInitialsDateI certify that the information provided is true and complete (copy) *I agree Captcha - to add Randy Send Application to Quality Progressions