Employment at PPH

List school name and location, years completed, course of study, and any degrees earned:

List the names, telephone numbers and years known of three references (do not include relatives or employers).

I certify that the information I have provided to the foregoing questions is true and correct, and no attempt has been made to conceal information. I authorize my former employers, schools and personal references to provide any information they may have regarding me, whether or not it is on their records. I fully agree that if I have ever been dismissed from employment or if it has been proven that I have ever absued a patient, client or resident, I am not eligible for employment at The Philadelphia Protestant Home. I hereby release them and their company from all liability for divulging same. I understand that if any information given by me in this application, is found to be false or misleading, I will be subject to dismissal at anytime during the prior of my employment. I also understand that a criminal background check will be conducted. If employment is obtained under this application, I will comply with all the rules and regulations of The Philadelphia Protestant Home. I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment. I represent and warrant that I have read and fully understand the foregoing, and that I seem employment under these conditions. I understand that I will be required to undergo a pre-employment physical and drug screening as a condition of my employment. AND I understand that if I am employed by PPh, my employment will be for no set period of time and may be terminated by PPh at any time with or without cause. I further understand that nothing shall change the at-will status of my employment other than a written agreement signed by me and The Philadelphia Protestant Home, expressly changing the employment-at-will status. I also understand that, if employed, I will be required to abide by all of the policies, rules and regulations of the organization.