New application
Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Can you work nights and weekends?
Employment Desired

Times available each day (i.e. 7am - 5pm):

Have you lived outside the state of Pennsylvania in the last two years?

Education - High School

Education - College / University

BUSINESS / TRADE SCHOOL

PROFESSIONAL SCHOOL

Work Experience Please list your work experience beginning with your most recent job held. If you were self-employed, list the company name. Attach additional sheets if necessary

Address
Address
City
State/Province
Zip/Postal
May we contact?

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. Please describe your duties below. Do not leave blank. MUST LIST DUTIES, DO NOT WRITE "SEE RESUME".

RECENT EMPLOYMENT #2

Address
Address
City
State/Province
Zip/Postal
May we contact?

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. Please describe your duties below. Do not leave blank. MUST LIST DUTIES, DO NOT WRITE "SEE RESUME".

RECENT EMPLOYMENT #3

Address
Address
City
State/Province
Zip/Postal
May we contact?

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. Please describe your duties below. Do not leave blank. MUST LIST DUTIES, DO NOT WRITE "SEE RESUME".

Have you ever been employed by Casmir?
Is any family member or significant other employed by Casmir?
How did you hear about Casmir? Check all that apply:

Please list two professional references who have served you in a supervisory capacity. I hereby give permission for Casmir to contact my professional references listed

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Please use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

Did you complete the application yourself?

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I have carefully read the application statement and have provided accurate information. The facts set forth in the application are true and complete. Permission is given to Casmir Care Services, Inc. (Casmir) to verify all information I have provided in this application. I authorize all persons or entities I have referred to in this application to provide any relevant information to Casmir or its agents for use in any investigations and hereby release them from any liability in doing so. I understand and agree that any omission or misrepresentation of facts in my application will be justification for refusal or termination of employment. I understand that this employment application and any other Casmir documents or statements are not contracts of employment. Employment is contingent upon satisfactory completion of employment requirements and reference checks. I understand that the results of my criminal record check and child abuse history clearance may be used to deny or terminate my employment. A minimum of two professional reference checks are required for employment, one of which must be from the applicant's current supervisor.

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