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Serving Berkeley, Jefferson and Morgan Counties
208 Old Mill Road Martinsburg, WV
(304) 263-5680
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Skilled Nursing
Physical Therapy
Occupational Therapy
Speech Therapy
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Interpretation Services
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Menu
Our Services
Skilled Nursing
Physical Therapy
Occupational Therapy
Speech Therapy
Home Health Aide
Medical Social Services
Dietician Services
Interpretation Services
Resources
Resources for Patients
Resources for Physicians
Area Hospitals
The “Basics” of Medicare
HIPAA Privacy Notice
About Us
Board of Directors
Our Staff
Fact Sheet
News
Pay My Bill
Donate
Events
Generous Hearts Social
Puttin’ Tournament
Careers
News
Contact Us
Employment Application
Panhandle Home Health, Inc. considers applications for all positions without regard to race, color, religion, creed, sex, national origin, disability, sexual orientation, citizenship status or any other legally protected status. PLEASE COMPLETE ENTIRE APPLICATION. You may submit a resume, but you must still complete all questions or your application will be deemed incomplete and may not be considered. If an entry field does not apply to you, please type NA.
Please enable JavaScript in your browser to complete this form.
Position applying for
*
Name
*
First
Middle
Last
Street Address
*
City, State, Zip
*
Email
*
Cell Phone
*
Home Phone
Other Phone
If you are under 18 years of age, can you provide required proof of your eligibility to work?
*
Yes
No
Have you ever filed an application with us before?
*
Yes
No
If YES, give date:
Have you ever been employed with us before?
*
Yes
No
If YES, give date:
Do any of your friends or relatives, other than spouse, work here?
*
Yes
No
If YES, their name and relationship to you?
Are you currently employed?
*
Yes
No
If YES, what is your current job title and department?
May we contact your present employer?
*
Yes
No
If YES, their name and position?
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
*
Yes
No
Proof of citizenship or immigration status will be required upon employment.
If required for position, do you have a valid driver's license?
*
Yes
No
If YES, provide State of issuance, license # and expiration date.
Are you currently on "lay-off" status and subject to recall?
*
Yes
No
Are you available to work:
*
Full Time
Part Time
Temporary
Can you travel if a job requires it?
*
Yes
No
Have you been convicted of a felony within the last five years?
*
Yes
No
A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.
Date available for work:
*
What is your desired salary range?
*
How did you learn about this employment opportunity at Panhandle Home Health? Check all that apply.
*
Ad in newspaper
Ad in magazine
Job Bulletin/Posting/Walk-in
Website
Employment Agency
Referral by employee
Other
EDUCATION - Name of High School
*
City/State
*
Did you graduate?
*
Yes
No
If YES, date of graduation
If NO, date of expected graduation
EDUCATION - Name of College/University #1
City/State
Did you graduate?
Yes
No
If YES, date of graduation
If NO, date of expected graduation
Major
Degree received
EDUCATION - Name of College/University #2
City/State
Did you graduate?
Yes
No
If YES, date of graduation
If NO, date of expected graduation
Major
Degree received
EDUCATION - Name of College/University #3
City/State
Did you graduate?
Yes
No
If YES, date of graduation
If NO, date of expected graduation
Major
Degree received
EDUCATION - Name of Other School
City/State
Did you graduate?
Yes
No
If YES, date of graduation
If NO, date of expected graduation
Major
Degree received
Other credentials/licenses/professional affiliations, etc., which are relevant to the job(s) for which you are applying.
SKILLS
Please list technical skills, clerical skills, trade skills, etc. relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert).
WORK EXPERIENCE
I have no previous work history.
Please detail your COMPLETE work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. Include full-time military or volunteer commitments. PLEASE DO NOT complete this information with the notation "See resume." PLEASE NOTE: Panhandle Home Health, Inc. reserves the right to contact all current and former employers for reference information.
Company Name #1
Address, City, State, Zip
Dates Employed (Most recent position)
Number of hours worked per week (Full or part time)
Title
Starting Salary
Final Salary
Supervisor's Name, Title and Phone Number
Other Reference Name, Title and Phone Number
Contact my current references:
At any time
Only if I am a finalist candidate
Primary Duties and Responsibilities
Reason for Leaving
Company Name #2
Address, City, State, Zip
Dates Employed
Number of hours worked per week (Full or part time)
Title
Starting Salary
Final Salary
Supervisor's Name, Title and Phone Number
Other Reference Name, Title and Phone Number
Contact my current references:
At any time
Only if I am a finalist candidate
Primary Duties and Responsibilities
Reason for Leaving
Company Name #3
Address, City, State, Zip
Dates Employed
Number of hours worked per week (Full or part time)
Title
Starting Salary
Final Salary
Supervisor's Name, Title and Phone Number
Other Reference Name, Title and Phone Number
Contact my current references:
At any time
Only if I am a finalist candidate
Primary Duties and Responsibilities
Reason for Leaving
Reference #1 - Name, Address, Phone Number
*
Reference #2 - Name, Address, Phone Number
*
Reference #3 - Name, Address, Phone Number
*
Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?
*
Yes
No
Will answer at interview
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
APPLICANT'S STATEMENT - Please type your name and the date of submission.
*
PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
Typing your name above indicates that you accept the terms listed below.
I certify that the answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of Panhandle Home Health, Inc.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Panhandle Home Health, Inc.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER.
To submit a formal resume, cover letter or additional work history, please email kbutts@panhandlehomehealth.org
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