Job Application form

Full Name*

First NameMiddle InitialLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Phone Number*

Area CodePhone Number

Do you have a valid driver's license?

YesNo

Are you authorized to work and remain in the United States?

YesNo

Were you ever discharged or forced to resign from any position?

YesNo

If Yes, Explain:

Have you ever been employed by Best Choice Personal Care LLC

YesNo

Are you related to any Best Choice Personal Care Client or Employee?

YesNo

Name of Employee:

Relationship:

Have you ever been convicted of any violation of the law? (Exclude traffic violations) A conviction will not necessarily disqualify an applicant from the position sought.

YesNo

If Yes, Explain:

Are you a High School Graduate?

YesNo

High School Equivalency?

YesNo

Are you presently attending school?

YesNo

Type of Education

Name of Instiution

Field of Study

Type of Degree

Did you Graduate?

YesNo

Do you have additional education to enter?

YesNo

Additional Type of Education

Name of Instiution

Field of Study

Type of Degree

Did you Graduate?

YesNo

Type

Serial Number

Date Issued

Expiration Date

MonthDayYear

Name of Employer:

Job Title:

Phone Number

Area CodePhone Number

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Supervisor:

Ending Salary Per Month:

Date started

MonthDayYear

Date ended

MonthDayYear

Reason for Leaving:

Description of Duties:

Do you have additional employers to enter?

YesNo

Name of Employer:

Job Title:

Phone Number

Area CodePhone Number

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Supervisor:

Ending Salary Per Month:

Date started

MonthDayYear

Date ended

MonthDayYear

Reason for Leaving:

Full Name

First NameLast Name

Description of Duties:

Inquiry may be made of your current and former employers/schools you attended.

May we contact your present employer?

YesNo

May we contact your former employers?

YesNo

Full Name

First NameLast Name

Business or Occupation

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Full Name

First NameLast Name

Business or Occupation

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Full Name

First NameLast Name

Business or Occupation

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

APPLICANT’S STATEMENT AND AUTHORITY TO RELEASE INFORMATION

(Required for ALL Positions)

I understand that this employment application and any other city documents are not contracts of employment, and any person hired may be terminated

by the employer at any time for any reason. I understand that any oral or written statements to the contrary are expressly disavowed and should not be

relied upon by a prospective or existing employee. I understand that Best Choice Personal Care LLC may modify, change, or revoke any of its employment policies,

pay practices, and benefits without my agreement. I hereby state that all answers on this application are true and understand that falsifying this

information can lead to termination if hired. I UNDERSTAND THAT IN ACCORDANCE WITH BEST CHOICE PERSONAL CARE LLC POLICY, FINAL CANDIDATES ARE SUBJECT TO

AN ALCOHOL / DRUG TEST AS A CONDITION OF EMPLOYMENT.

I hereby authorize any and all persons, companies, or agencies to release any and all background information, of a confidential or privileged nature,

including criminal history, relevant to this application and any pertinent information they may have to the hiring authorities of Best Choice Personal Care LLC. I release

all such parties from all liability of every kind as the result of furnishing the same to Best Choice Personal Care LLC. This information is to be used to assist the Best Choice Personal Care LLC

determining my qualifications and fitness for the position I am seeking. I hereby release Best Choice Personal Care LLC and its officers, agents and employees from any

liability for the use of any and all of the foregoing information, in consideration for being reviewed for the aforesaid position.

Should there be any questions regarding the validity of this release, you may contact me as indicated below Administrator at 414-306-6005

Full Name

Phone Number

Area CodePhone Number

Date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

The following information we are soliciting is strictly voluntary. This form will be kept separate and confidential from the application.

Information provided on this form will not be considered in any employment decision but is for statistical purposes only.

Tilte of Position Applied for:

Date

MonthDayYear

Full Name

First NameLast Name

Age

Gender

MaleFemale

Race/Ethnic Origin (Select ONLY One)

White (not of Hispanic origin): Persons having origins in any of the original people of Europe, North Africa, or the Middle East.Black (not of Hispanic origin): Persons having origins in any of the black racial groups of Africa.Hispanic: Persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish cultures or origins regardless of race.Asian or Pacific Islander: Persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samoa.American Indian or Alaskan Native: Persons having origins in any of the original people of North American and who maintain cultural identification through tribal affiliation or community recognition.

How did you learn about this position?

Do you have any physical or mental disabilities which may limit your ability to perform essential functions of this job or which would require any special accommodations?

YesNo

If Yes, Please explain:

Upload File (optional resume)

Upload a File

Signature

Application for Employment (call the office for a paper copy, or apply within)

Education:

Professional License or Certificate, If Required

Skills

Employment History

Personal References 3 are Required!!!

EQUAL EMPLOYMENT OPPORTUNITY QUESTIONAIRE