Waverly Heights Retirement Community

Waverly Heights, Ltd. Online Application

We consider applicants for all positions without regard to race, color, religious belief, national origin, age, marital or veteran status, the presence of a non-job related medical condition or handicap, or any other legally protected status.

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Position InformationPosition(s) Applying For:
Referral Source:

Personal Information

First Name:
Middle Name:

Last Name:

Email Address:

Address 1:
Address 2:

City:

State:

Zip Code:

Home Phone:
Mobile Phone:

ResumePlease upload your resume:

Work Qualifications

Have you ever lived in the State of Pennsylvania for the past two (2) consecutive years?Yes No

Have you ever filed an application here before?Yes No

Have you ever been employed here before?Yes No

Are you currently employed?Yes No

Please list any relatives employed by Waverly Heights Ltd or enter 'none' for none:

Are you legally authorized to work in the United States?Yes No

When can you start?

What is your availability?

Are you available to work weekends, overtime hours or holidays if required?Yes No
Please Explain:

Employment HistoryEmployer:
Address:
City:
State:
Zip Code:
Phone:
Dates Employed From:
Dates Employed To:
Final Position Held:
Hourly Rate/Starting Salary:
Hourly Rate/Final Salary:
Supervisor's Name:
Work Performed:
Reason for Leaving:
May we Contact this Employer?Yes No

Employer 2Employer:
Address:
City:
State:
Zip Code:
Phone:
Dates Employed From:
Dates Employed To:
Final Position Held:
Hourly Rate/Starting Salary:
Hourly Rate/Final Salary:
Supervisor's Name:
Work Performed:
Reason for Leaving:
May we Contact this Employer?Yes No

Employer 3Employer:
Address:
City:
State:
Zip Code:
Phone:
Dates Employed From:
Dates Employed To:
Final Position Held:
Hourly Rate/Starting Salary:
Hourly Rate/Final Salary:
Supervisor's Name:
Work Performed:
Reason for Leaving:
May we Contact this Employer?Yes No

Employer 4Employer:
Address:
City:
State:
Zip Code:
Phone:
Dates Employed From:
Dates Employed To:
Final Position Held:
Hourly Rate/Starting Salary:
Hourly Rate/Final Salary:
Supervisor's Name:
Work Performed:
Reason for Leaving:
May we Contact this Employer?Yes No

Special Skills and Qualifications

Summarize special skills and qualifications acquired from employment or other experience:

Have you a history or conviction for violent crime?Yes No

Have you ever been dismised from employment due to abuse of clients or residents?Yes No

Have you ever been charged/convicted of a crime in the past 10 years (conviction will not necessarily disqualify applicant from employment)?Yes No

EducationName of High School:
Highest level of High School classes completed?
High School Diploma:
Course of Study:
Describe specialized training, apprenticeship, skills, extracurricular activities and/or graduate studies completed:College/University:
Highest level of College Education completed?
College Degree:
Majors and Minors:
Describe specialized training, apprenticeship, skills, extracurricular activities and/or graduate studies completed:

Affidavit

I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire, or if hired, dismissal. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have with regard to any of the subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you. I authorize you to request and receive such information. If employed, I agree to conform to Waverly Heights rules and regulations and acknowledge that these rules and regulations may be changed, interpreted, withdrawn, or added to at any time with adequate prior notice to me. I further acknowledge that my employment may be terminated and any offer of employment or my acceptance of an employment offer, if such is to occur, may be withdrawn, with or without cause, and with or without prior notice, at any time, at the option of Waverly Heights or myself.

I also understand that all Waverly Heights employees are classified as probationary for the first 90 days of continuous service.

Please enter your initials below indicating you have read and agreed with the Legal Notice:

1400 Waverly Road, Gladwyne, PA 19035 • Phone 610-645-8600 • Fax 610-645-8611