Employment Opportunities – Peninsula Agency on Aging

Available Positions:

We strongly urge applicants to read the Employment Application form below, in it’s entirety, and collect all of the necessary information before submitting. Please be sure to indicate the position(s) you are applying for.

Thank you.

Peninsula Agency on Aging Employment Application

* Indicates Required Information

Full Legal Name
Permanent Address
Contact Information

List at least two (2) professional and one (1) personal reference you have known for at least three years who knows your qualifications (do not include family or friends).

Professional Reference 1
Professional Reference 2
Reference 3
Personal Background

Have you ever been dismissed or forced to resign or have you ever resigned in order to avoid being dismissed?

For purposes of compliance with Section 40.1-11.1 of the Code of Virginia, entitled "Employment of Illegal Immigrants," please state whether you are legally eligible for employment in the United States. (You are legally eligible for employment if you are a United States Citizen or if you have an appropriate permit to work in the United States issued by the U.S. Dept. of Justice or U.S. Dept. of Labor.)


If you possess any license (other than Driver's License), certificate or other authorization to practice a trade or profession, select yes below and enter the appropriate information.

License 1
Education - High School

If you did not graduate, do you have a high school equivalency certificate (GED)?

Do you have further education such as College, University, Trade School or Apprentice School that you would like to include in this application? If so, select Yes below.

Further Education
Further Education - Listing 2
Further Education - Listing 3
Additional Education, Training, and Special Skills

List any other education, training, special skills (Business, Secretarial, Vocational, Technical, Military or Correspondence courses) you have or possess related to this job. Give dates and number of hours certificates or licenses received in the box below.

Driving Information

List any moving violations during the last five (5) years in the box below.

Employment and Volunteer Experience

Starting with your most recent position, describe all paid, military, and applicable volunteer experience. Describe those duties and responsibilities that best demonstrate the position held.

Most Recent Position
Job Position 2
Job Position 3
Comments and Start Date

List any comments or qualifying statements you care to make about your qualifications, honors, membership in professional societies, etc., or amplify any statements made in this application.

On what date will you be available to start work? (It is understood that you must give adequate notice if you are presently employed.)

Applicant's Certification

Please read carefully before signing. If you have any questions regarding the following statements, please ask for assistance. Please verify your understanding of the following statements by entering your initials in the field below. By entering your initials, you electronically acknowledge reading and understanding the following 4 statements.

1) I understand that Peninsula Agency on Aging Inc. is an "at will" Employer and this application for employment is not an offer of an Employment Contract. PAA hire persons with the understanding that employee or employer for any reason or at any time may terminate employment.

2) I hereby certify that this application is a complete record and that all entries and all attachments are true and accurate to the best of my knowledge. I understand that all information on this application is subject to verification.

3) I consent to references and former employers being contacted in reference to being considered for employment unless noted above.

4) I understand that Peninsula Agency on Aging Inc. is a drug/alcohol testing and criminal history background check employer. I further understand that if I am offered a position with PAA, I must submit to drug and/or alcohol testing and that the results of these tests must be negative. If one or both of the tests yield positive results, the offer of employment will be withdrawn.

Signature and Date

Please electronically sign and date your application below. By entering your signature, you electronically acknowledge submission of your application to Peninsula Agency on Aging Inc.. Applications without dates and signatures will not be considered.

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