LB Homes Job Application
Desired Position
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Please Select
Director of Nursing (DON)
Home Care Administrator
Home Care Home Health Aide
Home Care RN Case Manager
LPN
LPN - Day/PM Team Lead
Nursing Assistant/Nursing Assistant in Training
Nursing Assistant/Care Attendant Assisted Living
Are you licensed or Certified for this desired position?
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Yes
No
Not applicable for this position
Please add your license or certification you currently hold or are in the process of completing.
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Please add your License or Certification you currently hold or are in the process of completing.
Are you 18 years of age or older?
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Yes
No
Your Name
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First Name
Last Name
Your Phone Number
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-
Area Code
Phone Number
Your Email Address
*
example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What type of employment are you interested in? (Check all that apply)
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Full Time
Part Time
Desired Shifts (Check all that apply)
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Day
Evening
Night
Some careers require weekend shifts, are you available on the weekend?
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Yes
No
Your Expected Rate of Pay?
Desired Number of Hours Per Week?
Please click the days you are available to work.
Please list any timeframes you are unable to work. If none, put (N/A).
Examples: Second and fourth weekend of each month, every Tuesday and Thursday.
Questions
Were you referred from a current LB Homes employee?
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Yes
No
Who referred you to LB Homes?
How did you learn about this job opening?
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Employee Referral
LB Homes Website
Facebook
School/College
Social Media
Job Service
Walk In
Online Search Site
Have you ever submitted an application at LB Homes before?
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Yes
No
Have you ever worked at LB Homes before?
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Yes
No
How many years of experience do you have applicable to this desired position?
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0
1-3 years
4-8 years
9-15 years
15-19 years
20 (plus) years
Please tell us why you've decided to work in your chosen career.
Have you ever been in a leadership or supervisory role?
Yes
No
Please tell us about your leadership or supervisory experience.
What makes someone a good leader?
Give an example of how you've earned the trust and confidence of someone.
What was the most difficult challenge you've encountered in your career and how did you overcome it?
Please tell us how you would understand or comfort a resident/patient that is unable to speak.
How have you displayed your dedication to your career.
What makes YOU unique from other applicants?
What is an acceptable reason to miss work and why?
What makes for great customer service when taking care of a resident/patient?
Experience
Work or Volunteer Experience
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Job or Volunteer Title
Name of Company or Organization
Start Date
End Date
Supervisors Name & Phone Number
Please describe your role and responsibilities.
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Work or Volunteer Experience
*
Job or Volunteer Title
Name of Company or Organization
Start Date
End Date
Supervisors Name & Phone Number
Please describe your role and responsibilities.
*
Work or Volunteer Experience
Job or Volunteer Title
Name of Company or Organization
Start Date
End Date
Supervisors Name & Phone Number
Please describe your role and responsibilities.
Education & Skills
Education
*
School or College Name
Level Completed
Start Date
End Date
Desired Start Date (Month/Day/Year)
Education
School or College Name
Level Completed
Start Date
End Date
Desired Start Date (Month/Day/Year)
Education
School or College Name
Level Completed
Start Date
End Date
Desired Start Date (Month/Day/Year)
Please describe any relevant skills applicable to the desired position you are applying for.
*
References
References are non-relatives who you have had a professional relationship with (ie. teacher, former employer, clergy, mentor, etc.).
Reference
*
Full Name
Phone number
Email Address
Reference
*
Full Name
Phone number
Email Address
Reference
Full Name
Phone number
Email Address
EEOC - Voluntary Self-Identification Survey
This employer is required to notify all applicants of their rights pursuant to federal labor laws. For further information, please review this notice from the Department of Labor: EEO is the Law poster. You may have additional rights pursuant to recent amendments to federal labor laws. Please review these protections from the EEO is the Law Supplement.
Gender
*
Male
Female
Non-Binary
I decline to answer
Ethnic Origin
African American or Black
American Indian or Alaskan Native Alaskan
Hispanic or Latino
Native Hawaiian
Two or More Races
White
I Decline to Answer
Veteran Status
This employer is required to take affirmative action to employ and advance in employment protected veterans pursuant to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002. Government contractors are required to take affirmative action to employ and advance veterans in employment: 1. Disabled veterans; 2. Recently separated veterans; 3. Active duty wartime or campaign badge veterans; and 4. Armed Forces service medal veterans. We are also required to submit an annual report to the U.S. Department of Labor identifying the number of our employees belonging to each specified -protected veteran- category.
Are you a protected veteran?
*
Yes
No
I decline to answer
Self-Identification of Disability
Q: How do I know if I have a disability? A: You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Autism, Bipolar disorder, Blindness, Cancer, Cerebral Palsy, Deafness, Diabetes, Epilepsy, HIV/AIDS, Impairments requiring the use of a wheelchair, Intellectual disability (previously called mental retardation), Major depression, Missing limbs or partially missing limbs, Multiple sclerosis (MS), Muscular dystrophy, Obsessive compulsive disorder, Post-traumatic stress disorder (PTSD), and Schizophrenia.
Voluntary Self-Identification of Disability
*
Yes, I have a disability or previously had a disability
No, I do not have a disability
I Decline to Answer
Reasonable Accomodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.
Please explain your reasonable accommodation request.
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