The Employment Application can be filled out electronically below. If completing the form online, please print the completed form to a PDF and email it to us at: eagle8pch@gmail.com The application can also be printed and mailed to us at:

Eagle Valley Personal Care Home
500 Front Street, PO Box 8969
Milesburg, PA 16853

Eagle Personal Care Home, Inc. is an EOE and will not discriminate on the basis of race, color, religious creed, disability, ancestry, national origin (including limited English proficiency), age or sex.

    1. Applicant Information Step 1 of 7

    Present Address

    Previous Address

    2. Miscellaneous Information Step 2 of 7


    Have you ever worked for any of the above Companies before?




    3. Employment Desired 3 of 7

    Days & Hours available to work

    If restrictions, indicate available hours below.

    Monday

    Tuesday

    Wednesday

    Thursday

    Friday

    Saturday

    Sunday

    4. Education & References Step 4 of 7

    Education

    High School


    College


    Business Trade, Other


    References

    Reference 1

    Reference 2

    Reference 3

    5. General Information Step 5 of 7


    6. Former Employers Step 6 of 7

    List below last three employers, starting with your present or most recent employer.

    Employer No. 1 (present or most recent)

    Employed

    Rate of Pay

     :

     :

    Employer No. 2 (present or most recent)

    Employed

    Rate of Pay

     :

     :

    Employer No. 3 (present or most recent)

    Employed

    Rate of Pay

     :

     :

    7. Signature & Submit Step 7 of 7

    READ CAREFULLY BEFORE SIGNING

    I certify that all my answers in this Employment Application are true and complete to my best knowledge, and I understand that this Application will
    remain active for thirty (30) days only.
    I authorize the Company to Investigate and verify my answers and I give the Company permission to contact schools, previous employers,
    references, and other in its investigation. I release both the Company and the party providing the information from any liability for this purpose. I also
    release the Company from any liability for providing information about my employment record to any prospective employer, government agency,
    or other party having a legal and proper interest.
    I also authorize the Company to secure financial and credit information through a consumer reporting agency, and I understand that, upon my written
    request made within a reasonable time, the consumer reporting agency will provide me with additional information concerning the nature and scope
    of any credit report investigation. I also agree to participate in computerized interviewing, assessment testing, and any other similar Company
    requirements which are conditions of employment.
    I understand that any false or misleading answer in this Employment Application or other pre-employment inquiry is grounds for rejection of my
    Application or immediate termination if I have been employed.
    If employed, I will comply with all Company policies and rules found in any Company policy manual, employment handbook, or other communication
    from the Company. I understand that the Company may require drug and alcohol testing as a condition of employment, subject to applicable federal
    and state laws, and I consent to any such testing.
    I agree not to use or disclose outside my employment with the Company any confidential information, trade secret, or proprietary information,
    whatever its form, obtained in connection with my employment with the Company.
    I understand that employment with the Company will be TERMINABLE AT WILL, that no employment contract will be valid unless made in writing and
    signed by the Company's President, Vise President, Secretary or Treasurer, and that my employment may be ended at any time, for any reason,
    by me or the Company.