LIVING AN INDEPENDENT LIFESTYLE (LIL), LLC

Living An Independent Lifestyle (LIL), LLC is committed to equal opportunity employment. Our policy ensures that all applicants are treated fairly and without discrimination based on race, color, national origin, age, disability, or veteran status, in adherence to protected status requirements.

Todays Date

Date

Full Name

Address

Street Address Line 2

CityState

Zip code

Number of years at this address

Mobile

Format: (000) 000-0000.

Job Position Applied for

Certification(s) and number(s)

Are you 18 years or older?

Are you eligible to work in the U.S?

Are you a U.S citizen?

Do you have reliable transportation?

If hired what is your method of transportation

Have you ever been convicted of a felony?

if so what dates

Date

Do you require reasonable accommodation(s) to work:

Please share any additional information you believe may qualify you for the position

| certify that the information provided on this application is accurate and truthful. I understand that providing false or misleading information will be the basis for elimination and/or dismissal of my application or employment if hired. | authorize Living An Independent Lifestyle, to conduct a thorough investigation of my educational background and with previous employment(s I authorize the employer(s) and educational institution(s) designated as references to fully and freely disclosed information necessary for determining best outcomes for hiring. If an employment relationship is created, I understand that unless | am offered a specific written contract signed on behalf of Living an Independent Lifestyle (LIL) LLC owner and CEO the employment relationship will be at will. In other words, the employment relationship will be entirely voluntary in nature and either I or the employer will be able to terminate the employment relationship at any time without cause. With appropriate notice I will have the full and complete discretions to end the employment relationship when I choose and for reasons of any choice. Correspondingly, my employer will have the same right. Additionally, no agent, representative, or employee of Living An Independent Lifestyle except in a specific written contract of employment signed on behalf of Living an Independent Lifestyle (LIL) LLC owner and CEO has the power vary the voluntary nature of the employment relationship. | have carefully read the above certification and I understand and agree to its terms.

Filename: :Livinganindependentlifestyle.com Email Address: LIL@livinganindependentlifestyle.com

Applicant Signature

Date

Upon your hire date, it is mandatory to submit a front and back copy of your driver's license and social security card.

Caregivers employed or hired by Living An Independent Lifestyle (LIL), LLC, and officially recognized as (LIL) employees, are explicitly prohibited from initiating negotiations for caregiver supportive services with (LIL) client(s) for personal financial gain. LIL considers such behavior as egregious and intolerable, and it may lead to fines of up to $8,000.00.

Filename: Livinganindependentlifestyle.com Email Address: LIL@livinganindependentlifestyle.com