Employment Application

Describe any training or life skills you have that apply to caring for adults:

We’d love to learn more about your recent academic background. Please note that sharing this information will not impact your employment with Prestige Home Care Agency.

Please enter a valid phone number or email so we can contact in case of an emergency. 

List the previous 2 of employment history, starting with the most recent employer.

Please provide at least two references. Your application will not be considered unless two professional references are provided.

Please be sure to complete the attached authorization to do a criminal and motor vehicle background check.

It is illegal in Philadelphia for employers to ask about your criminal background during the job application process. Employers cannot ask about your criminal background on job applications or during any job interview. Employers can run your criminal background check ONLY AFTER a conditional offer of employment is made (final hiring depends on the results of your background check).

• Criminal convictions can be considered ONLY if they occurred less than 7 years from when you apply (not counting time of incarceration).

• Arrests that did not lead to conviction cannot be used in any employment decisions.

If your background check reveals a conviction, the employer must consider: The type of offense and the time that has passed since it occurred; Its connection to the job you are applying for; and your job history, character references, and any evidence of rehabilitation.

Employers can reject you based on your criminal record ONLY if you pose an unacceptable risk to the business or to other people. If you are rejected, the employer must send the decision to you in writing with a copy of the background report used to make the decision. You have 10 days to give an explanation of your record, proof that it is wrong, or proof of rehabilitation.

APPLICANT CERTIFICATION AND RELEASE: I certify that I have read and understand the applicant note on page one (1) of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I understand that this application is not a contract of employment. My employment is contingent upon confirmation of credentials and successful completion of drug test or criminal background check. I also understand that if hired, regardless of any oral presentations to the contrary, the employment relationship between the Company and myself is terminable at-will, so that both the company and I remain free to choose to end our work relationship at any time for any or no reason. Any changes in this employment relationship must be made in writing.

By signing below, I confirm that I have read, understood, and agree to the job description and disclosures. I certify that all the information I have provided is true and accurate to the best of my knowledge. I also acknowledge that I am willing to provide testimony if required.