Employment

Employment

Applicant Information

Name
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Address
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Are you a citizen of the United States?
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?
MM slash DD slash YYYY
Have you ever been convicted of a felony?

Education

Address
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MM slash DD slash YYYY
Did you graduate?
Address
MM slash DD slash YYYY
MM slash DD slash YYYY
Did you graduate?
Address
MM slash DD slash YYYY
MM slash DD slash YYYY
Did you graduate?

References

Please list 3 professional references.
Name
Address

Name
Address

Name
Address

Previous Employment

Address
Supervisor
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact your previous supervisor for a reference?

Address
Supervisor
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact your previous supervisor for a reference?

Address
Supervisor
MM slash DD slash YYYY
MM slash DD slash YYYY
May we contact your previous supervisor for a reference?

Military Service

MM slash DD slash YYYY
MM slash DD slash YYYY

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
MM slash DD slash YYYY
Lancaster

Larry Ruise-Director
[email protected]

Nyjah Ruise-Executive Director
[email protected]

The Phoenix Program
Dana Michniewicz-Clinical Director
[email protected]

1.Lebanon

James Anthony-Director
[email protected]

Nyjah Ruise-Executive Director
[email protected]

The Phoenix Program
Dana Michniewicz-Clinical Director
[email protected]

1.Chester

Mike Stofflet-Executive Director
[email protected]

Nyjah Ruise-Executive Director
[email protected]

1.Delaware

LaFennis Terry III-Director
[email protected]

Nyjah Ruise-Executive Director
[email protected]

1.Montgomery

Mike Stofflet-Executive Director
[email protected]

Nyjah Ruise-Executive Director
[email protected]

The Phoenix Program
Dana Michniewicz-Clinical Director
[email protected]

1.Bucks

James Anthony-Director
[email protected]

Nyjah Ruise-Executive Director
[email protected]

The Phoenix Program
Dana Michniewicz-Clinical Director
[email protected]

1.Luzerne

LaFennis Terry III-Director
[email protected]

Nyjah Ruise-Executive Director
[email protected]

The Phoenix Program
Dana Michniewicz-Clinical Director
[email protected]