Loving Hands HomeCare Application

Job Application

Please complete the form below to apply for a position with us.
Full Name*

First NameMiddle Initial Last Name
Birth Date*

MonthDayYear
SSN*
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email Address*
example@example.com
Phone Number*
Position Applying For*
Are you a previous employee of LHHC?*
Were you referred by a LHHC employee? If so please provide the name here
Available Start Date*

MonthDayYear
Upload Your Resume if available

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Most Recent Employment History *
Employment History Continued *
Education History *
Education History Continued
Please list any special training/skills related to the position you are applying for
Are you currently certified in CPR*

YesNO
If so please upload it here

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References (please provide the information of 3 professional references) *

	Name	Contact Number	Business	Years known
Reference 1
Reference 2
Reference 3

Please provide a copy of your Photo Identification

Ex. Drivers License, Passport
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Please provide a secondary proof of identification

Ex. Birth Certificate or Social Security Card
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I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statement contained herein and the references and employers listed above to provide you with information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liablilty from any damage that may result from utilization of such information.

I understand that a criminal records check is necessary prior to my employment. I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that certain convictions will automatically result in disqualification from employment."

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

I understand that Loving Hands HomeCare is an at will employer.
Please certify that you have read the information listed above *

I understand
Signature*

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Job Application