• Name
  This field is for validation purposes and should be left unchanged.
• Applicant Name*
  First Last
• Thank you for your interest in our Agency!
•  Due to the large number of applications we receive and the competitive nature of our employment process, specific reasons for employment decisions will not be released unless specified by law.
•  In completing our application, you may be subject to the following checks:

Employment Reference Check
Criminal Background Check
Pennsylvania Child Abuse History Clearance
FBI Finger Print Check
Physical Examination
Medical Assistance Fraud
Driving Record
Two Step TB Test
Drug Screen

AUCP is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status.

• Position*
  Please type the name of the position you are applying for.
• Applicant Address*
  Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code
• County*
• Phone*
• Email*

• Educational Background

• Education Level*
  • Highschool
  • College
  • Graduate School
  • Business/Trade/Other

• HIGH SCHOOL

• High School Diploma*
  • HSD
  • GED
  • NONE

• COLLEGE

• College Name
• College Major Subject
• College Years Attended
  Select Years Attended12345
• College Degree
  If you did not receive a degree then type NONE

• GRADUATE SCHOOL

• Graduate School Name
• Graduate School Major Subject
• Graduate School Years Attended
  Select Years Attended12345
• Graduate School Degree
  If you did not receive a degree then type NONE

• BUSINESS/TRADE/OTHER

• Other School Name
• Othe School Major Subject
• Othe School Years Attended
  Select Years Attended12345
• Othe School Degree
  If you did not receive a degree then type NONE

• KEY SKILLS

• Key Skills*
  How many hours, would you prefer, weekly?
• Key Skills
  Please list all the languages you speak fluently.

• How Did Your Hear About Us?*
  Please check any and all that apply.
  • Print Advertisement/Newspaper
  • Radio Ad
  • Employment Agency
  • Walk‐In
  • Job Fair
  • Website
  • Television Commercial
  • Conemaugh Hospital TV
  • Facebook/Twitter/Instagram
  • Flyer
• Did an employee refer you?*
  • YES
  • NO
• Please list the employee that referred you.*

• EMPLOYMENT HISTORY

• Previous Employment*
  Please list, at least, your most recent employer. Applicants are encouraged to list up to three (3) companies.
  • 1
  • 2
  • 3

• Company One

• Company Name*
• Phone
• Address
  Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code
• Date Started
  MM slash DD slash YYYY
• Date Left
  MM slash DD slash YYYY

• Company Two

• Company Name
• Phone
• Address
  Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code
• Date Started
  MM slash DD slash YYYY
• Date Left
  MM slash DD slash YYYY

• Company Three

• Company Name
• Phone
• Address
  Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code
• Date Started
  MM slash DD slash YYYY
• Date Left
  MM slash DD slash YYYY

• It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application. The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law.
  
  
• Submission Date*
  MM slash DD slash YYYY
• Submit Application*
  • Yes, I understand and give permission.
  • No, I do not understand nor give permission.
  You understand and give permission to process the application as stated in the terms.