Application

Employment Application
An equal opportunity employer, Sleep Well CPAP Services, LLC does not discriminate in hiring or terms and conditions of employment because of an individual 's age (40 and older), ancestry, color, religious creed (including religious dress and grooming practices), disability (mental and physical), marital status, medical condition (cancer and genetic characteristics), genetic information, military and veteran status, national origin (including language use restrictions), race, sex (which includes pregnancy, childbirth, breastfeeding, and related medical conditions), gender, gender identity, gender expression, sexual orientation, or any other basis protected by federal, state, or local law, ordinance or regulation.
Upload Resume*

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Date of application*

MonthDayYear
Date
Position desired*
Schedule desired*

Full-timePart-time
Pay expected: $
Personal Information
Name*

First NameLast Name
Are you authorized for employment in the U.S?*

YesNo
Present Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived there?*
Previous Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long did you live there?
Home Phone Number*
Please enter a valid phone number.
Other Numbers
Please enter a valid phone number.
Social Security Number
If you are under the age of 18, please state your age

Additional Information
Additional Information
Is there any additional information involving a change of name or assumed name that will permit us to check your work record?
Have you ever been employed by CPAP Services?*

YesNo
Employment dates

MonthDayYear
Date
Location(s)
Position held
List names of friends or relatives now or formerly employed by CPAP Services.
Person to contact in case of emergency
Name*

First NameLast Name
Phone*
Address*

Name and Address of Employer (1)
Employment History

List employment starting with your most recent position. Account for any time during this period that you were unemployed by stating the nature of your activities.
May we contact your current employer?*

YesNo
Name and address of employer

1
Dates (From: / To:)
Business Name
Address
Phone Number
Please enter a valid phone number.
Job Title
Supervisor
Reason for leaving
Work Performed

Special Skills and Qualifications
Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired from employment or experience.

Please Read This Statement Carefully (signature)
I hereby affirm that the information given by me on this application is complete and accurate. I understand that any falsification or omission either on this application, or otherwise providing false information, will be immediate grounds for dismissal, no matter what or when the falsification or omission is discovered. If I receive a conditional offer of employment, I authorize a thorough investigation to be made in connection with this application concerning my character, general reputation, personal characteristics, employment, education, and criminal record, whichever may be applicable for employment purposes.

If I am hired, I agree that my employment and compensation may be terminated at will, with or without cause, and without notice at any time, at the option of Sleep Well CPAP Services, LLC, or me.

I have read and affirm as my own the above statements.
Applicant's signature*

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Date*

MonthDayYear
Date
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Employment Application