Title
DR MISS MR MRS MS

First Name *

Last Name *

Email Address *

Which office(s) would you perfer to work within? *
Allentown
Altoona
Bradford
Clarion
Clearfield
Erie
Hermitage
Indiana
Lewisburg
Lewistown
McConnellsburg
Oil City
Warren
Wellsboro
Williamsport

Position Applied For: *

Application Date: *

Home Address *

City *

State *

Zipcode/Postcode *

Country *
-- Select Country -- AFGHANISTAN ALAND ISLANDS ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA CÔTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JERSEY JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT BARTHÉLEMY SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT MARTIN SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SERBIA AND MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES UNITED STATES MINOR OUTLYING ISLANDS URUGUAY UZBEKISTAN VANUATU VENEZUELA VIETNAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE

Home Phone Number *

Cell Phone Number *

Social Security Number: *

Date Available for Work: *

Employment Type: *
Full Time
Part Time

Were you ever employed by CRI previously? *
Yes
No

If previously employed, please list dates of employement, your department, and your position. *

List any relatives or friends working for this organization, including their name and your relationship.

Work Experience - Please list present and former employers beginning with the most recent. Be sure to include dates employed, company name and address, phone number, postion(s) held, a description of your work, supervisor, last wages, and reason for leaving. *

May we contact the above employers? *
Yes
No

If no, indicate which employers you do not wish us to contact.

How did you learn of this position? *
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CareerLink posting
Referred by another person
Walk-in
Other

If referred by another person, please let us know who that other person is... *

Please list any special skills and qualifications that you have below. *

Education - Please list all education experience below. Be sure to include the name of the school, school address, years completed, when you graduated, and your courses of study. *

Professional References - Please list three personal references below excluding family members. Be sure to include their name, address, phone number, and years known. *

Miscellaneous Information - Have you ever been convicted of a crime in the past 7 years, exlcuding misdemeanors and summary offenses, which has not been annulled, expunged, or sealed by a court? (A conviction record will not necessarily be a bar to employment) *
Yes
No

If yes, please explain and describe in full detail:

Can you verify your legal rights to work in the U.S. by providing a birth certificate, proof of U.S. Citizenship, or by some other means? *
Yes
No

If you are under the age of 18 can you furnish a work permit? *
Yes
No

Are you able to perform the jobs for which you are applying? *
Yes
No

Applicant's Certification - Please read carefully. Employment at Will: If employed, I understand and agree that such employment may be terminated at any time, without prior notice, and that my employment will not be governed by any expressed or implied contract but is at will.  I certify that the best of my knowledge and belief, the answers given by me to the foregoing questions and the statements made by me in this application are correct and complete.  I understand that misrepresentation or omission of facts in this application may result in my discharge. I hereby give the employer the right to investigate all references unless otherwise herein.  I understand that submission of criminal records check is a condition of employment with the company.  Failure to submit to such a check will result in ineligibility for hire or my employment being terminated.  I understand that my employer is a Drug-Free Workplace employer.  (Please print and sign your name below as well as date.) *

Application Information Release - I hereby authorize any person, educational institution, or company I have listed as a reference on my employment application to disclose in good faith any information they may have regarding my qualifications and fitness employment.  I will hold Community Resources for Independence, Inc., any former employers, educational institutions, and any other entities providing references free of liability for the exchange of this information and any other reasonable and neccessary information incident to the employment process. (Please print and sign your name as well as date below.*

Fair Credit Reporting Act: Disclosure/Authorization - In accordance with the provisions of sections 604(b)(2)(A) of the Fair Credit Reporting Act (FCRA) (Title II, Subtitle D, Chapter I, Public Law 104-208) you are hereby informed that a consumer report about you may be ordered for employment purposes (Under the provisions of the Act, a driving record and criminal record check (Act 34 and Act 33) is considered a consumer report when used for employment purposes).  I, the Undersigned, acknowledge receipt of the above disclosure and authorize the above named company to obtain a consumer report about me for its use to employment purposes. (Please print and sign your name below as well as date.) *