Employment Application

Employment Application

Apply for your desired position by filling out the form below.
Full Name

First NameMiddle NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Position Applying For
Upload Your Resume

Cancelof
Briefly describe why you are a good fit for this position.
Address

Street Address

Apartment Number/Suite
CityState / ProvincePostal / Zip Code
Gender
Eye Color
Hair Color
Country of Birth
Race
Primary Language
Other Languages You Speak
Are you currently working?
Which days can you work?
What hours can you work?
Can you work with dogs?
Can you work with cats?
Can you work around cigarette smoke?
Employer Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Start Month
Start Day
Start Year
End Month
End Day
End Year
Employer Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Start Month
Start Day
Start Year
End Month
End Day
End Year
Employer Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Start Month
Start Day
Start Year
End Month
End Day
End Year
Have you ever worked for Lifestyle Home Care Services?
Are you a re-hire?
W-4 filing status
I-9 Employment Eligibility Documentation
I-9 Employment Eligibility Documentation will be provided on or before the first day of work
Do you give Lifestyle Home Care Services permission to conduct a criminal background check on you?
Do you give Lifestyle Home Care Services permission to conduct a drug screen and fingerprint on you?
Signature for Background and Fingerprint Consent
Hep B Vaccine – Declination and Acceptance
Upload Certificate or License

Cancelof
Upload Government ID (e.g., driver’s license)

Cancelof
Upload State ID

Cancelof
Upload Social Security card or other government-issued ID

Cancelof
Upload U.S. Passport

Cancelof
Upload Green Card

Cancelof
Upload Work Authorization Card

Cancelof
Upload Voided Check

Cancelof
Upload Current Physicals

Cancelof
I have read and understand Lifestyle Home Care Services' employment application, and I certify that all information and entries I have provided are true, complete, and accurate to the best of my knowledge. I further understand that if my background check yields negative or unsatisfactory results, my employment may be immediately terminated.
Signature for Application
Should be Empty: