Lifeline Companion Services, Inc.
  • APPLICATION FOR EMPLOYMENT

    APPLICATION FOR EMPLOYMENT

  • Lifeline Companion Services, Inc.

  • 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, medical condition, national origin or marital status

  • Select Yes or No

    Open to
  • Hourly Work*
  • Live-In 1-2-Days*
  • Live-In 3-5-Days*
  • List times you are available to work each day

  • Basic Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Do you have a car you can use on the job:
  • Education

  • Completed High School?
  • EXPERIENCE & SKILLS:

  • Experience & Skills (Check all that apply)
  • Employment History

    Please list the last 3 most recent jobs held
  • Start Date
     / /
  • End Date
     / /
  • Format: (000) 000-0000.
  • Employment History #2

  • Start Date
     / /
  • End Date
     / /
  • Format: (000) 000-0000.
  • Employment History #3

  • Start Date
     / /
  • End Date
     / /
  • Format: (000) 000-0000.
  • Certification and Release: I certify that I have read and understand the application 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 to verify any information including but not limited to criminal history and motor vehicle driving records. I authorize all people, 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 also understand that the use of illegal drugs is prohibited during employment.

  • Date
     / /
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  • Should be Empty: