General Information:

LifePath cannot guarantee the privacy of your SSN sent via this internet form. If you choose not to include it, please be aware that a SSN will be required at the next stage of the application process.

List any relatives who are currently employed at LifePath:

(All relatives employed by LifePath are required to be listed)


High School:


Vocational or Tech School:

Graduate Work:

EMPLOYMENT HISTORY (Please start with your most recent position. If you have worked for any other human service agencies, you must include that information):

REFERENCES (please include two work related references not supervisors or relatives, whom you have known at least one year):


I hereby give LifePath the right to make a thorough investigation into my previous employment, education, references and all statements made by me in connection with my application for employment, credit and criminal records check, and any other information relative to my employment; and I release from all liability all persons, companies, and corporations supplying such information.

I understand that any false answer, statement or representation made by me in this application shall constitute cause for denial of employment or discharge. I also understand that nothing contained in this employment application or the granting of an interview is intended to create a contract between LifePath and myself for either employment or for the granting of benefits. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon LifePath unless made in writing. If an employment relationship is established, I understand and agree that it is not for a definite period of time and that I have the right to terminate my employment at any time and that LifePath retains a similar right.

I understand that any offer of employment is conditioned upon my successful completion of a criminal background check, employee physical/TB/chest x-ray and a driver’s license check when applicable.

I understand that, if accepted for employment, I will be required to abide by the rules and policies of LifePath and that I will be on three (3) months orientation for full-time or six (6) months for part-time before being considered a regular employee.

I understand that a check of my Criminal History Background will be conducted by LifePath, Inc. Based upon the program in which I have applied, this investigation may include one or more of the following:

  • PA State Police Criminal Record Check
  • PA Child Abuse History Clearance
  • FBI Criminal Background Check

I understand that if I am hired, I must cease working should a satisfactory Child Abuse Clearance Report not arrive by the 30th calendar day of employment.

I understand that if I am hired, I must cease working should a satisfactory FBI Criminal Background Check not arrive by the 90th calendar day of employment.

If I am found to have a conviction for one or more of the prohibitive offenses as outlined by both LifePath policy and regulations, I will not be hired or will be dismissed.