Now Hiring!

Online Employment Application

Personal Information

Position Information

Employment History

Education

References

Applicant Statement

Now Hiring!

Online Employment Application

Personal Information

Position Information

Employment History

Education

References

Applicant Statement

Employer 1

School 1

Reference 1

Reference 2

Make a difference in someone's life - be a caregiver with CPNC!

Central Penn Nursing Care offers rewarding positions for companions, personal care aides, certified nurse aides, LPNs & RNs!

You are looking for competitive wages and scheduling that fits your needs - our clients are looking for a companion with a helping hand.

Be a blessing to someone in need, be a CPNC caregiver.

Caregivers & Companions — needed for all shifts.
CNAs and skilled PCAs — needed for all shifts.
LPNs — all shifts needed for extended care facilities work.

If you are interested in employment with Central Penn Nursing Care, with offices in Lancaster and Elizabethtown, please complete all portions of the form below and submit it to us by simply clicking the "Send Now" button. If your interests and qualifications meet our needs, we will call you to schedule a personal visit and interview at one of our offices.

First Name		Last Name
Address
City		State	Zip
Email
Home Phone		Cell Phone
	*include area code with no spaces, ex. 5551236789
Are you legally eligible for employment in this country?
	Yes	No
Have you ever pled "guilty" or "no contest", or been convicted of a felony?
	Yes	No
	If "yes", please provide date(s) and details:

Position(s) applying for:	Companion/Homemaker
	PCA	CNA
	LPN	RN
	Other

Have you submitted an application to CPNC Inc. or Nurses Direct before?

Yes

If "yes", please provide date(s) and postion(s):

Starting with your most recent employer, provide the following information. Please provide your last 8 years of work history or as much of your past work history as you can.

Number of Past Employers:

Employer 1
Employer
Address
City			State	Zip
Phone
	*include area code with no spaces, ex. 5551236789
Supervisor
Why did you leave?		Still Employed
		Terminated
		Resigned
		Laid Off
Amount of resignation notice given:				(number of days)
Dates Employed:			to	(MM/DD/YYYY)
	Yes		No
Summarize the type of work performed and job responsibilities:

Compensation:
	Hourly		Salary
	Amount		$
May we contact this company for reference? (We will not contact this employer without your permission.)
	Yes		No	Later

Starting with your most recent school attended, provide the following information:

Number of Schools Attended:

School 1
School
City		State	Zip
Years Completed
Completed	Diploma
	Degree
	Certification
	GED
	Other
Major
Minor

List the name and telephone # of two business/work references. The references may not be a relative and should be a previous supervisor, teacher, professor, or individuals who are aware of your work ethics.

By submitting this application on-line, you are certifying that all the information you are providing to us is true, complete and correct. If you have an interview with us, you will be asked to sign a formal statement for verification of all of the information in your application.

I agree that all information provided in this application is true, complete and correct.(Check this box for agreement.)

I Agree

Reference 1

First Name

Relationship

Years Known

Phone Number

*include area code with no spaces, ex. 5551236789