Human Resources

Application For Employment

General Position Education Employment Authorization Review Submit

Applying For: Personal Care Aide (PCA)

We are an Equal Opportunity Employer and do not discriminate in hiring on the basis of race, color, religion, national origin, sex, sexual orientation, ancestry, veteran or military status, marital status, handicap status, disability, or age. No information on this application is intended to secure information to be used for such discrimination. This application will be given consideration, but its receipt does not imply that the applicant will be employed.

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General Information

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Position Information

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Education

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Employment Experience

Work Related References

Give names of persons we may contact to verify your qualifications for the position.

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Authorization for Search and Exchange of Information

New York State Law requires that this facility obtain a criminal history record check before employing any unlicensed/licensed individual to provide care or supervision to our residents.

As part of this process, your fingerprints will be electronically scanned and sent to the DCJS and the results provided to New York State Department of Health by DCJS and the F.B.I. The facility will also receive the results of your scan.

You may withdraw your application for employment at anytime, without prejudice, prior to the decision on employment. The employer is prohibited from hiring any individual whose history check reveals a mandatory disqualifying offense. You will have the opportunity to obtain, review and explain the information contained in the criminal history record check.

I, hereby authorize Masonic Care Community to submit a request to the Attorney General of the United States to conduct a search of the records of the Criminal Justice Information Services Division of the Federal Bureau of Investigation for any criminal history records corresponding to the fingerprints or other identification information submitted by me. I further authorize the exchange of such information between the Attorney General of the United States, the New York State Department of Health and Masonic Care Community, and within its healthcare system (i.e. among "sister" nursing homes/home care agencies). This information may be used by Masonic Care Community and only for the purpose of determining my suitability for employment.

I further authorize and request any present or former employer, educational institution, law enforcement agency, financial institution, or other persons having personal knowledge about me to furnish to the Masonic Care Community, and/or its agents, with any and all information in their possession regarding me, in connection with an application of or retention of employment. I hereby release from liability and hold harmless all persons and corporations supplying this information. A photocopy of this authorization is an effective as the original.

Review

Please review and confirm that all of your application information below is accurate before submitting.

General Information edit

Position Information edit

Education edit

Employment Experience edit

Authorization for Search and Exchange of Information edit