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Employment Application

Full Name*

Current Address*

Phone*

Email Address*

Do you have a valid Driver's License? *

All Acquired Education - Check all that apply*

Name of HS or GED Institution?*

Name of College Educational Institution?*

Are you 18 years of age or older?*

Have you ever applied for employment with Kelsch Associates before?*

If you have applied for employment with Kelsch Associates before, list the date(s) below:*

Are you a previous employee of Kelsch Associates, Inc?*

Please list dates of prior employment with Kelsch Associates:*

Reason for leaving employment with Kelsch Associates*

Are you willing to work at ANY of our locations?*

Are you willing to attend Staff Meetings?*

Will you attend training sessions?*

Will you change Attends/Depends briefs on adults?*

Will you assist in transferring individuals?*

Will you work with individuals with challenging behaviors?*

Do you have current school obligations?

Name and Location of School*

Dates of Term (beginning and end)?*

Will you be receiving college credits?*

List school schedule below including days of week and class times:*

If hired, do you have other work obligations?*

If you have other work obligations:*

Are you interested in a Program Support Manager position?*

Are you interested in a Full Time (FT) Resident Program Worker position?*

Are you interested in a Part Time (PT) Resident Program Worker position?*

Are you interested in a Full Time FACT Activity Aide position?*

Are you interested in more than one shift/position?*

Current Employer Name*

Current Employer Address*

Current Employer Phone Number*

Date of Hire for Current Employer

If you plan on leaving your current place of employment, please list reason(s) why and how much notice you will provide:*

Name of Previous Employer #1 (most recent)*

Address of Previous Employer #1*

Phone Number of Previous Employer #1

Dates of Employment Employer #1*

Reason for leaving Previous Employer #1*

Name of Previous Employer #2*

Address for Previous Employer #2*

Phone Number of Previous Employer #2*

Date of Employment for Previous Employer #2*

Reason for leaving Previous Employer #2*

Name of Previous Employer #3*

Address of Previous Employer #3*

Phone Number for Previous Employer #3*

Dates of Employment for Previous Employer #3

Reason for leaving Previous Employer #3*



This Employment Application is for Kelsch Associates, Inc. of Pennsylvania, located in Chester County.


Kelsch Associates, Inc. of Pennsylvania is an Equal Opportunity Employer.


This is a shortened version of our Employment Application.  If you are selected for an interview you will have to complete the additional sections at the time of interview.


*All fields are required.  If not applicable, note NA or none.

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