• Job Application

    Job Application

    Loving Light Home Care LLC
  • Today's Date
     / /
  • Format: (000) 000-0000.
  • Position Applied For*
  • Are you legally eligible to work in the US?*
  • Are you available to work Call Outs, if needed?*
  • Have you ever been employed at Loving Light Home Care LLC*
  • Do you have any friends or family employed at this location?*
  • Have you been convicted of a crime in the last (7) years? (FYI: Conviction will not be deciding factor in continuing the pre-screening process or potential employment)*
  • During the hiring process, do you agree to provide a criminal background check?*
  • During the hiring process, do you agree to provide a Motor Vehicle Record?*

  • Educational Background

    Please answer the following questions

  • List previous educational history

  • Did you graduate?*
  • Did you graduate?*

  • Document Checklist

  • CNA/HHA/PCA/Homemaker Certification*
  • Expiration
     - -
  • CPR/First Aid*
  • Expiration
     - -
  • Driver's License*
  • Expiration
     - -
  • TB Screening*
  • Expiration
     - -

  • Employment Background

  • References: List the name, relationship, number of years acquainted, and a phone number of three references. (No relatives please)

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • **CERTIFICATION AND RELEASE: I certify that I have read and understand the application note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentation of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumers reporting bureaus, to verify any information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I understand that I am not obligated to disclose sealed or expunged records of conviction or arrest. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

    We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability, national origin, ancestry, veteran status, medical condition, sexual orientation, marital status or any other characteristic protected by applicable state or federal civil rights laws.

  • Date
     / /
  • Should be Empty: