JOB APPLICATION

JOB APPLICATION

Benevolent Hands, LLC
Benevolent Hands, LLC

1387 N Shadeland Ave, Ste E

Indianapolis, Indiana 46219

Benevolent Hands, LLC is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all of the sections below:
Applicant Name
Address
City State and Zip Code
Telephone Number
Email Address
example@example.com
Date of Application

MonthDayYear
Date
Employment Position Position(s) applying for: Personal Service Attendant
How did you hear about this position
What days are you available for work
What hours or shift are you available for
What hours or shift are you available for work
On what date can you start working if you are hired

MonthDayYear
Date
Do you have reliable transportation to and from work
Have you ever applied to or worked for Benevolent Hands, LLC before?
Salary desired
Do you have any friends, relatives, or acquaintances working for Benevolent Hands, LLC
If yes when
Are you 18 years of age or older? Are you a U.S. citizen or approved to work in the United States?
If yes state name relationship
What document can you provide as proof of citizenship or legal status
Will you consent to a mandatory controlled substance test? Have you ever been convicted of a criminal offense (felony or misdemeanor)? If yes, please state the nature of the crime(s), when and where convicted and disposition of the

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered
Vocational School/Specialized Training
Please list below the skills and qualifications you possess for the position for which you are applying
(Note: Benevolent Hands, LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional. )
Name
Location City State
Year Graduated
Degree Earned
Name
Location City State
Year Graduated
Degree Earned
Name
Location City State
Year Graduated
Degree Earned
Are you a member of the Armed Services
What branch of the military did you enlist
How many years did you serve in the military
What was your military rank when discharged
What military skills do you possess that would be an asset for this position
Previous Employment Employer Name:
Supervisor Name
Job Title
City State and Zip Code
Employer Address
Employer Telephone
Dates Employed

MonthDayYear
Date
Reason for leaving
Job Title
Address

Employer Address

Street Address Line 2

City State and Zip CodeState / Province

Postal / Zip Code
Supervisor Name
Employer Telephone
Dates Employed

MonthDayYear
Date
Reason for leaving
Job Title
Address

Employer Address

Street Address Line 2

City State and Zip CodeState / Province

Postal / Zip Code
Supervisor Name
Employer Telephone
Reason for leaving
Dates Employed

MonthDayYear
Date
References Please provide 2 personal and professional reference(s) below:

The relationship between you and the Benevolent Hands, LLC is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Benevolent Hands, LLC. No representative of Benevolent Hands, LLC has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Oficer or the Company's President.
Applicant Signature

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Dated

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