1.800.345.1780    |    Contact Us Contact Us

Employment Application

Beacon Light Behavioral Health Systems is an Equal Opportunity Employer and prohibits discrimination on the basis of race, color, religious creed, disability, ancestry, national origin, age or sex.

General Information
Position Applying for:

Desired Work County:


I am seeking:  



Dates Available:
I am available for: 

If part time, indicate max hours per week:
Shift Preferred:



Were you referred by a current
Beacon Light employee? If so, please
provide their name:  
     
Personal Information
Last Name: First Name: Middle:
Street Address: City: State/Zip:
Telephone: Cell Number:
Email Address:  
If hired, can you present evidence of U.S. Citizenship or your legal right to work in this country?
 
Have you ever been employed by this Agency?

If yes:
mm/yy
Position:
Are you at leas 21 years old?

(per regulation certain direct care positions require applicants to be at least 21)
Applicants must submit Child Abuse, PA Criminal History Record, and FBI certifications (Acts 33/34/114). Criminal convictions and child abuse indications or substantiation may preclude individuals from being hired. More information can be obtained at http://www.dhs.pa.gov/provider/childwelfareservices/childabusehistoryclearanceforms/

Have you ever been convicted of a crime?  
If Yes, describe in full (include dates & state):


Have you ever been excluded/debarred from participation in a federal or state program?  
If Yes, describe in full:
Applicants must also complete Act 31 Recognizing and Reporting Child Abuse training which can be completed for free at https://www.reportabusepa.pitt.edu
     
Education
  Years Completed School Name City/State Degree/Major Did You Graduate?
High School (specify if GED)  
College
Graduate/Other
Military Experience (list branch of service, highest rank, length of service, and/or training received)
           

Certification/License Document # State Issued Expiration Date
       
Work Experience (Most recent first. Include voluntary work and military experience.)
Employer: Telephone: From (mm/yy):
Address: To (mm/yy):
Job Title: Last Salary:
Specific Duties:
Reason for Leaving: Supervisor:
May we contact this employer?
     
Employer: Telephone: From (mm/yy):
Address: To (mm/yy):
Job Title: Last Salary:
Specific Duties:
Reason for Leaving: Supervisor:
May we contact this employer?
     
Employer: Telephone: From (mm/yy):
Address: To (mm/yy):
Job Title: Last Salary:
Specific Duties:
Reason for Leaving: Supervisor:
May we contact this employer?
     
Special Skills
List any special training, skills, or abilities relevant to the position for which you are applying (e.g. Med passing, CPR, First Aid, Running Groups)
 
References (List 3 persons, not related to you, whom you have known for at least one year)
Name Telephone Years Known
     
I certify information provided is true and complete. I authorize investigation of all statements contained in this application for employment. This application shall be considered active for 90 days after which a new application will be required. I understand an employment relationship with Beacon Light Behavioral Health Systems (BLBHS) is “at will”, which means an Employee may resign at any time and the Employer may discharge Employee at any time without cause. “At Will” employment may not be changed except in writing by the Chief Executive Officer. I authorize BLBHS to obtain information from employer(s) and school(s) attended. I authorize employer(s) and school(s) to disclose to BLBHS such information as may be requested about me, including but not limited to copies of evaluations, transcripts, and any information regarding disciplinary actions and performance. I authorize BLBHS to conduct background checks including drug screening and criminal background checks as may be necessary. I release BLBHS and schools and employers from any liability associated with furnishing information as specified above. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand, also, that I am required to abide by policies, rules, regulations and laws applicable to employment.
     
Signature:
(By entering your full name, you are electronically signing this application.)
Date:
     

You will be taken to a confirmation page once your application has been received.