Form
LIGHTUP HEALTHCARE SERVICES LLC
EMPLOYMENT APPLICATION
Thank you for your interest in joining Light Up Healthcare Services LLC. Please complete this application fully. A member of our team will contact you once your application is recieved.
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you legally authorized to work in the United States?
*
Yes
No
Are you at least 18 years old?
*
Yes
No
Position
*
Direct Support Professional/Caregiver
Personal Assistant
CNA
LPN
RN
Office/Admin Staff
Other
Do you have caregiver experience?
Yes
No
I have worked with:
Elderly
Intellectual/developmental disabilities
Physical disabilities
Children
Elderly
Availability
Full-time
Part-time
PRN
Weekend only
Night shift
Evening shift
Available shift
Days (8am-8pm)
Nights (8pm-8am)
Weekends
Have you been convicted of any crime?
*
Yes
No
If yes, explain below:
Have you ever been cited for abuse or neglect?
*
Yes
No
If yes, explain below:
Do you have a valid Driver's license?
*
Yes
No
List additional qualifications, licenses or certificates below:
Upload certificate or Resume
Browse Files
Drag and drop files here
Choose a file
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I consent to background/driving record checks
I understand this position requires : (a) Ability to Lift 50 lbs (b) Standing for Extended Periods (c) Documentation of Care
I certify that all information is accurate.
I consent to background checks and verify my eligibility to work in the U.S.
Signature
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Continue
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