Draylon Healthcare Services Employment Application

DHCS Draylon Healthcare Services, LLC:

Houston, TX 77066 | Direct Contact: (281) 642-3386 dhealthcaresvcs@gmail.com | www.draylonhealthcareservices.com
DHCS Application for Employment:

Draylon Healthcare Services is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other characteristic protected by federal, state, or local law.
Personal Information:

Please Note: Incomplete applications may result in disqualification from further consideration. Be sure to complete all required fields accurately and thoroughly.
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Number*

Area CodePhone Number
Mobile Number*

Area CodePhone Number
E-mail*
Birth Date*

MonthDayYear
Are you eligible to work in the U.S.?*

YesNo
Do you have a valid driver's license?*

YesNo
Are you at least 18 years or older? (If no, you may be required to provide authorization to work.)*

YesNo
Have you ever been terminated from employment or asked to resign by an employer?*

YesNo
If yes, please provide company names and relevant details. If no, please enter N/A:*
Can you work any shift?*

YesNo
If there are any shifts you are unable to work, please explain below: (Include specific days or times and the reason, if applicable.)
Can you work overtime, including weekends?*

YesNo
Are you able to perform the essential functions of the position you are applying for, with or without reasonable accommodation?*

YesNo
Date You Can Start*

MonthDayYear
Hourly rate/Salary desired:*
Position desired:*
Are you currently employed?*

YesNo
If yes, may we contact your present employer? *
Referral Source:
How did you hear about us?

AdvertisementReferralRecruiterOther
Have you ever worked for this company before?*

YesNo
Explain:
Do you know anyone who works for our company?*

YesNo
If yes, who?
Education:
High School*
Name of High School Attended
Number of Years Attended*
Graduated?*

YesNoOther
College
Name of College/University Attended
Number of Years Attended
Graduated?

YesNoOther
Area of Study/Degree
Graduate School
Name of Graduate School Attended
Number of Years Attended
Graduated?

YesNoOther
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

YesNoOther
Area of Study/Degree
Skills/Qualifications:

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain below.
Skills*
List any relevant skills
Qualifications*
List any relevant certifications or qualifications
Employment History:

Include your last (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. (Incomplete information could disqualify you from further consideration)
Current Employer Name:*
Name of Current Employer or NONE if not Employed
Start Date

MonthDayYear
Job Title | Summarize the nature of work performed and job responsibilities: *
Address:
Phone Number

Area CodePhone Number
Immediate Supervisor and Title:
Previous Employer*
Name of Previous Employer
Start Date

MonthDayYear
End Date

MonthDayYear
Job Title | Summarize the nature of work performed and job responsibilites: *
Address:
Phone Number

Area CodePhone Number
Immediate Supervisor and Title:
Reason for Leaving?*
Previous Employer*
Name of Previous Employer
Start Date

MonthDayYear
End Date

MonthDayYear
Job Title | Summarize the nature of work performed and job responsibilities: *
Address:
Phone Number

Area CodePhone Number
Immediate Supervisor and Title:
Reason for Leaving?*
References:

Please provide the names of three individuals, not related to you, whom you have known for at least three (3) years. We may contact your references prior to an interview.
Reference 1*
Name of Reference
Address | Phone | Email*
Company*
Years Acquainted*
Reference 2*
Name of Reference
Address | Phone | Email*
Company*
Years Acquainted*
Reference 3*
Name of Reference
Address | Phone | Email*
Company*
Years Acquainted*
Send Application:
Applicant Acknowledgement and Authorization:

By clicking the submit button below, I understand that the completion of this application or any other part of the employment process does not create an obligation for Draylon Healthcare Services to hire me. If I am offered employment, I understand that either I or Draylon Healthcare Services may terminate the employment relationship at any time, for any reason, with a two-week notice. I further understand that no representative of Draylon Healthcare Services has the authority to make any assurance to the contrary.

By signing below, I certify that all information I have provided in this application is true and complete to the best of my knowledge. I have not withheld or misrepresented any requested information. I authorize Draylon Healthcare Services to contact any references I have listed to verify the information provided. I understand that any false or misleading information, or the omission of material facts, may disqualify me from further consideration for employment, or if hired, may result in immediate dismissal.
Date of Application:*

MonthDayYear
Date
Full Name:*
Should be Empty:

DHCS Draylon Healthcare Services, LLC:

DHCS Application for Employment:

Personal Information:

Referral Source:

Education:

Skills/Qualifications:

Employment History:

References:

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