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Who We Are
What We Do
Services for the Sight Impaired
Services for the Intellectually Disabled
Prevention of Blindness
Document Destruction
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Get Involved
Ways to Give
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Employment Application
Applicant Information
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First
Middle
Last
Address
Street Address
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State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
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Anguilla
Antarctica
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Aruba
Australia
Austria
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Bahamas
Bahrain
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Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
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Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
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Dominican Republic
Ecuador
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Equatorial Guinea
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Eswatini
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Gabon
Gambia
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Germany
Ghana
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Grenada
Guadeloupe
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Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
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Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
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Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
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Lao People's Democratic Republic
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Lebanon
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Liberia
Libya
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Luxembourg
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Türkiye
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Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
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Åland Islands
Country
Phone
Email
Date Available
MM slash DD slash YYYY
Desired Salary
Position Applied For
Select a Position
Adult Training Facility Lead
Services Supervisor
Direct Care Worker
Warehouse Assistant
Driver
Light Assembly Tacker
Photo ID Technician
Volunteer – Front Desk
Volunteer – Vision Screenings
Are you a citizen of the United States?
(Required)
Yes
No
If no, are you authorized to work in the U.S.?
(Required)
Yes
No
Have you been a PA resident for the past two-years?
(Required)
Yes
No
Have you ever worked for this company?
(Required)
Yes
No
If so, when?
Have you ever been convicted of a felony?
(Required)
Yes
No
If yes, explain
Education
High School
High School
Address
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Did you graduate?
Yes
No
Degree
Other
College
Address
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Did you graduate?
Yes
No
Degree
College
Other
Address
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Did you graduate?
Yes
No
Degree
References
First Reference
Full Name
Relationship
Company
Phone
Address
Second Reference
Full Name
Relationship
Company
Phone
Address
Third Reference
Full Name
Relationship
Company
Phone
Address
Previous Employment
First Position
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason For Leaving
May we contact your previous supervisor for a reference?
Yes
No
Third Position
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason For Leaving
May we contact your previous supervisor for a reference?
Yes
No
First Position
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason For Leaving
May we contact your previous supervisor for a reference?
Yes
No
Military Service
Branch
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Rank at Discharge
Type of Discharge
If other than honorable, explain
Disclaimer
(Required)
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.