Proof of eligibility will be required if hired. If you haven't lived in the state of Pennsylvania for the last 2 years, you will be required to complete an FBI fingerprint through the Dept. of Human Services.

Please list your work experience for the beginning with your most recent job held.
If you were self-employed, give firm name.

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I hereby authorize Croyle-Nielsen Therapeutic Associates, Inc., its employees, contractors, affiliates, and designees to perform all necessary screenings and checks in order to consider me for employment, including but not limited to Pennsylvania State Police Criminal History Check (EPATCH), FBI Cogent Criminal History Check, Child Abuse Registry Record Check, Driving Record Check (if job applied for requires driving), and Pre-employment drug screening. I understand that all employment offers potentially extended to me will be contingent upon all such screenings and checks yielding results deemed acceptable to Croyle-Nielsen Therapeutic Associates, Inc. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment, and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

We are an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age, height, weight, or disability. We assure you that your opportunity for employment with us depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.