Call or text our 24-Hour Victim Services Helpline at 814-944-3585.
2022 Broad Ave, Altoona, PA 16601
(814) 944-3583
* Name (First, Middle, and Last)
* Email
*Telephone
* Address
* City
Have you resided in PA for the past five consecutive years? YesNo
Previous Address if Above is Less Than Two Years
Are you willing to work: DaysNightsWeekends
If yes, specify available times to work weekend shifts.
Are you presently employed? YesNo
Have you ever applied to the agency before? YesNo
If yes, when?
How did you find out about this position?
High School
High School Level Completed 9101112
College or University
Level Completed 1234
Graduate or Professional
Special training or continuing education courses related to position desired:
1. Company Name
Company Address
Describe your main duties or responsibilities.
2. Company Name
3. Company Name
May we contact these employers as a reference? YesNo
1. Name and Occupation
Address
Telephone
2. Name and Occupation
3. Name and Occupation
Were you ever indicted or convicted of child abuse? Were you ever convicted of a criminal offense? (Omit minor traffic violations and any offense committed before your 18th birthday that was finally adjudicated in a juvenile court or under a youth offender law.) If yes, give details on a separate sheet of paper. Conviction of a criminal offense is not a bar to employment in all cases. Each case is considered on its merits. YesNo
Please include any additional information that you think would be applicable: e.g., volunteer experience, internships, membership in professional organizations. Exclude any information which would describe race, sex, age, marital status, national origin, religious or political affirmations.
I hereby certify that the information provided by me in this application is true to the best of my knowledge. I understand that any misrepresentation or falsification made to Family Services can be grounds for refusal of employment. I further understand that, if employed, any false statement or misrepresentation provided by me herein or in conjunction with the application process may be cause for dismissal.
I understand and agree that the employment relationship that may result from my application will be at will, and either Family Services or I may terminate the employment relationship at any time.
I authorize Family Services to verify any statements made in this application or provided during the application process. I also authorize Family Services to contact the references and previous employer(s) listed on my application, unless explicitly indicated otherwise.
Accessibility Tools