Application - Penn Life Sciences

Your Name(Required)

E-Mail Address(Required)

Telephone(Required)

Alternative Telephone

Your Current Address

Street Address(Required)

Town / City(Required)

State(Required)

Country(Required)

1. Please indicate your gender:

Male

Female

Other

Prefer not to say

2. ***Please indicate if you are either Hispanic or Latino: (if yes please skip to question #4)

Yes

3. Please indicate which of the following categories best describes your race but not including Hispanic or Latino (*** If yes to #2 then please skip this question and go to #4):

Caucasian

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

American Indian or Alaskan Native

4. Are you entitled to or are receiving disability benefits under laws administered by the Veterans Administration for a disability of 30% or more, or have you been discharged or released from active military duty for a disability incurred or aggravated in the line of duty?

Yes

5. Did you serve on active duty in the U.S. Armed forces for a period of more than 180 days, any portion of which occurred between August 5, 1964 and May 7, 1975?

Yes

6. Do you have a physical, mental, or emotional impairment which substantially limits any major life activity, or for which you would require a reasonable accommodation in order to perform the job for which you have applied?

Yes

If yes, please describe any desired or necessary accommodations:

Are you currently able to commute to or plan to relocate to the Newtown/Langhorne Pennsylvania area(Required)

Yes, I can reliably make the commute and/or am planning to relocate in the near future

No, I currently cannot make the commute

If you are planning to relocate, when is the earliest you can do so:

Are you legally authorized to work in the United States(Required)

Yes

Will you now or in the future require sponsorship for employment visa status (e.g., H-1B visa status)?(Required)

Yes

If you are currently employed, please briefly describe the reasoning behind why you are leaving:

If you are currently not working, what was the reason you had left your last position

Employment desired(Required)

Full time Only

Part-time Only

Temporary

Seasonal

Salary or hourly rate desired

How Many hours can you work weekly?

Will you work overtime if required?(Required)

Yes

When are you available to start?(Required)

Can you work evenings?(Required)

Yes

Can you work weekends, if required

Yes

Have you submitted an application here before?(Required)

Yes

If yes, for what position were you interviewed?

NOTE: Answering “yes” to the following questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (In answering these questions, do not include minor traffic infractions and convictions for which the record has been sealed or expunged, any conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed, referrals to and participation in any pre-trial or post-trial diversion programs, and marijuana-related offenses that occurred over two years ago.)

Have you ever pled “guilty” or “no contest” to, or been convicted of, a misdemeanor or felony?(Required)

Yes

If yes, please give the date and details:

Education History

Name of School	Location (Complete mailing address)	Years Completed	Major & Degree	Actions

There are no Entires.

Work Experience

Please list all fulltime and/or part-time work experience for the past five years beginning with your current or most recent employer. ALL INFORMATION MUST BE COMPLETED. If you were self-employed, give firm name. Attach additional sheets if necessary.

Work Experience

Name of employer	Employer Address (street address, city, state, zip)	May we contact this employer?	Name & title of supervisor	Employment start date	Employment end date	Compensation start	Your last job title: FT or PT	Reason for leaving (be specific)	List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.	Actions

There are no work experiences.

Explain any gaps in your employment, other than those due to personal illness, injury or disability.

Computer Skills

Word Processing

Yes

Years

Internet

Yes

Years

Database

Yes

Years

Spreadsheet

Yes

Years

Presentation (PowerPoint, etc.)

Yes

Years

E-mail

Yes

Years

Other

Personal References

List names and telephone numbers of three business/work references who are not related to you. If not applicable, list three school or personal references who are not related to you.

Name	Relationship	Actions

There are no Personal References.

Referral Source (Please check the appropriate category and name the source)

Walk-in

Job Fair

Penn Life Sciences Website

Employee

School

Staffing Agency

Other

Government Employment Agency

Please read the following Applicant Statement carefully before signing:

I certify that all information I have provided in order to apply for and secure work with Penn Life Sciences, Inc. is true, complete and correct.

I hereby give Penn Life Sciences, Inc. the right to make a thorough investigation of my past employment, education and activities and I hereby authorize and request any present or former employer, educational institution, law enforcement agency, financial institution, or persons having personal knowledge about me to furnish Penn Life Sciences, Inc., and/or its agents, with any and all information in their possession regarding me in connection with an application for employment. I release from all liability and hold harmless all persons, companies, organizations and entities supplying this information to Penn Life Sciences, Inc. and/or its agents. I further indemnify Penn Life Sciences, Inc. against any liability that might result from making such investigations. A photocopy of this authorization is as effective as the original. I certify under the pains and penalties of perjury that the facts stated herein are true and correct to the best of my knowledge, and that I have not omitted or concealed any relevant information. I understand that any false answers, slanders or implications made by me in this application or any other required documents, regardless of when they are discovered, shall be considered sufficient cause for denial of employment or discharge.

I understand that Penn Life Sciences, Inc. does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I further understand that nothing contained in this Employment Application or in the granting of an interview is intended to create an employment contract between Penn Life Sciences, Inc. and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon Penn Life Sciences, Inc. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and Penn Life Sciences, Inc. retains a similar right. I also recognize this application is conditional upon my presenting to Penn Life Sciences, Inc. proper documents showing that I am eligible to work in the United States, I agree to submit to Penn Life Sciences, Inc. the documents required by law showing work eligibility. I will provide Penn Life Sciences, Inc. with copies of all employment and/or confidentiality agreements between me and any of my former employers that may contain continuing obligations on my part to any such employer.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient case to cancel further consideration of this application or immediately discharge me from Penn Life Sciences, Inc.’ service, whenever it is discovered.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature

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Application for Employment

Your Current Address

Education History

Work Experience

Computer Skills

Personal References