Instilling hope.
Inspiring change.
Building community. 

Online Application
  1. Personal Information
  2. Date(*)

    Please enter Date
  3. Last Name(*)
    Please Enter Last Name
  4. First Name(*)
    Please Enter First Name
  5. Middle Name
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  6. Home Phone
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  7. Cell Phone
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  8. Email Address
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  9. Permanent Street Address Line 1(*)
    Please enter \"Street Address\"
  10. Permanent Street Address Line 2
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  11. City(*)
    Please enter \"City\"
  12. State(*)
    Please enter \"State\"
  13. Zip Code(*)
    Please enter \"Zip Code\"
  14. Are you elgibile to work in the United States of America?(*)
    Please answer \"Are you a citizen of the United States of America?\"
  15. If no, Type of Visa
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  16. Immigration Number
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  17. Have you ever applied for employment with us?(*)
    Please answer \"Have you ever applied for employment with us?\"
  18. Employment Type(*)





    Please enter \"Employment Type\"
  19. Position of Interest
    Please enter position(s) applying for
  20. If Other, Please Specify
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  21. How did you learn about employment with Penn Foundation?





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  22. Education
  23. High School
  24. Name
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  25. Location
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  26. Course of study
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  27. Number of years completed
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  28. Did you graduate?


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  29. Degree or Diploma
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  30. Business/Trade/Technical School
  31. Name
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  32. Location
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  33. Course of study
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  34. Number of years completed
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  35. Did you graduate?


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  36. Degree or Diploma
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  37. College
  38. Name
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  39. Location
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  40. Course of study
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  41. Number of years completed
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  42. Did you graduate?


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  43. Degree or Diploma
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  44. Graduate School
  45. Name
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  46. Location
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  47. Course of study
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  48. Number of years completed
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  49. Did you graduate?


    Invalid Input
  50. Degree or Diploma
    Invalid Input

  51. Employment Record
  52. Previous Employer #1
  53. Company Name
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  54. Phone Number
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  55. Address
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  56. Job Title
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  57. Name of Supervisor
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  58. Describe your job
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  59. Employed From
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  60. Employed To
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  61. Starting Wage
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  62. Ending Wage
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  63. Reason for Leaving
    Invalid Input
  64. May we contact this employer for a reference?


    Invalid Input
  65. If no, Why not?
    Invalid Input
  66. Previous Employer #2
  67. Company Name
    Invalid Input
  68. Phone Number
    Invalid Input
  69. Address
    Invalid Input
  70. Job Title
    Invalid Input
  71. Name of Supervisor
    Invalid Input
  72. Describe your job
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  73. Employed From
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  74. Employed To
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  75. Starting Wage
    Invalid Input
  76. Ending Wage
    Invalid Input
  77. Reason for Leaving
    Invalid Input
  78. May we contact this employer for a reference?


    Invalid Input
  79. If no, Why not?
    Invalid Input
  80. Previous Employer #3
  81. Company Name
    Invalid Input
  82. Phone Number
    Invalid Input
  83. Address
    Invalid Input
  84. Job Title
    Invalid Input
  85. Name of Supervisor
    Invalid Input
  86. Describe your job
    Invalid Input
  87. Employed From
    Invalid Input
  88. Employed To
    Invalid Input
  89. Starting Wage
    Invalid Input
  90. Ending Wage
    Invalid Input
  91. Reason for Leaving
    Invalid Input
  92. May we contact this employer for a reference?


    Invalid Input
  93. If no, Why not?
    Invalid Input
  94. Miscellaneous Information
  95. Please explain any periond of unemployment
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  96. References
  97. Name
    Invalid Input
  98. Relationship
    Invalid Input
  99. Address
    Invalid Input
  100. Telephone Number
    Invalid Input
  101. Name
    Invalid Input
  102. Relationship
    Invalid Input
  103. Address
    Invalid Input
  104. Telephone Number
    Invalid Input
  105. Name
    Invalid Input
  106. Relationship
    Invalid Input
  107. Address
    Invalid Input
  108. Telephone Number
    Invalid Input
  109. Have you ever been convicted of a crime (including Military Service)?(*)


    Please answer \"Have you ever been convicted of a crime (exclude summary or misdemeanor offenses)?\"
  110. If yes, please provide exact details of conviction.
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  111. Have you ever been reprimanded, suspended, or excluded from participation by Medicare, Medical Assistance, or any other state or federal health plan?(*)
    Have you ever been reprimanded, suspended, or excluded from participation by Medicare, Medical Assistance, or any other state or federal health plan?
  112. If yes, please provide exact details.
    Invalid Input
  113. Additional Comments
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  114. Employment Application Release The information provided on this application for employment is true and complete. If employed, any misstatement or omission of fact on the application may result in my dismissal.
    I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to employ me in the future.
    I understand that if I am employed it will be on a probationary or trial basis for a period of at least 90 days. I also understand and agree that employment with Penn Foundation, Inc is on an at will basis and my employment may be terminated or my job/position may be terminated, without cause, and without prior notice, at any time.
    I do hereby give Penn Foundation permission to check my references and to hold said references blameless for anything they may say.
  115. Applicant's Signature (My typed name shall have the same force and effect as my written signature).(*)
    Please enter \"Applicant\'s Name\". This will be considered your signature on this application.
  116. Date(*)

    Please enter the \"Date\" of your \"signed\" application.
  117. Attachments
  118. Attachment #1
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  119. Attachment #2
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  120. Penn Foundation provides equal employment opportunities to all persons without regard to race, color, national origin, ethnicity, age, religion, sex, sexual orientation, marital status, disability, or veteran's status. Penn Foundation is affiliated with Mennonite Health Services.

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