Employment Application – Clinical 12 Hour Shift

Your Name (required)

Address (required)

Phone (required)

Can we text you at the number you provided? (required)
Yes, you can text meNo, please call me

Email (required)

Are you available to work alternating weekends and holidays? (required)
YesNo

Were you ever employed by Living Branches or any affiliated community including The Willows of Living Branches, Souderton Mennonite Homes, or Dock Woods? (required)
YesNo

If so, when and at which campus?

Were you referred by a current employee?
YesNo

If so, who referred you?

Please indicate the community at which you would prefer to work:
The Willows of Living Branches - HatfieldSouderton Mennonite Homes - SoudertonDock Woods - Lansdale

Please indicate the position you are most interested in:
Registered NurseLicensed Practical NurseCertified Nursing AssistantResident AssistantMedication Technician

Do you have the following license/certifications active in the state of Pennsylvania?
RN LicenseLPN LicenseCertified Nursing Assistant LicenseMedication Technician CertificationNo license

Which shift are you interested in?
FirstSecondThird

Upload Resume

My electronic signature below certifies that all statements and information given herein are correct and accurate. In consideration of Living Branches' evaluation of my suitability for employment, I hereby authorize Living Branches to perform all checks of my credentials as allowed by law including, but not limited to, discussions with employers, supervisors, co-workers, friends, business associates, or other individuals that Living Branches in its sole discretion believe may have relevant information regarding my suitability for employment. I further authorize Living Branches to perform the following checks on my credentials; State Criminal Record Check and/or Federal Bureau of Investigation Criminal Background Check, and such other checks as Living Branches deems appropriate. I agree to complete any post-offer physical evaluations that Living Branches may require including a pre-employment physical and testing for illegal or unauthorized substances. I understand that any offer of employment is contingent upon my successfully passing the physical evaluation requirements and the background investigation. I agree not to assert any claims or causes of action of any kind against Living Branches, its agents, its employees, or any individuals or companies contacted by Living Branches as part of its investigation, from any and all claims, demands, damages, actions, causes of action, or suits of any kind of nature whatsoever arising from Living Branches' investigation of my credentials. I understand that any false answers or statements made by me on this application, any supplement thereto or in connection with the above-mentioned investigations may be grounds for refusal of employment, invalidate my employment or, if employed, grounds for immediate discharge I acknowledge that Living Branches has made no representation of any kind as to whether employment will be offered at conclusion of its investigation. If I am offered and accept employment with Living Branches, I agree to abide by the rules and the policies of Living Branches and understand that my employment is at will and terminable at any time for any reason either by myself or by Living Branches. My typed name below represents my electronic signature which acknowledges that I have read and understand the entire application and agree to the terms and conditions outlined above.