Join Our Team – Inspirational Care LLC

INSPIRATIONAL CARE LLC

EMPLOYMENT APPLICATION

First Name

Last Name

SS# : *

DL# Or ID#: *

MI:

Present Address: *

Home Phone

Mobile Number

Email Address *

Permanent Address, if different from present address:

If hired can you Provide Proof that you are legally able to work in the United States? *YesNo

Have you ever been convicted of a criminal offense (felony or misdemeanor)? *YesNo

lf yes, please state nature of offense(s), date(s), city, state and disposition on a separate sheet of paper. Nole: An affirmative answer will no/ necessarily result in disqualification for employment:

List any relatives or friends employed by the Company And Your Relationship with them *

EMPLOYMENT

Position Desired: *

Salary Desired: *

What days and hours are you available for work? *

Are you available for overtime? *YesNo

Are you over 18 years of age? *YesNo

When are you available to begin work?

If under 18, can you provide a work permit? *YesNo

Are you able to Perform the essential functions of the job for which you are applying? *YesNo

(Note: We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be
necessaryfor eligible applicants to perform essential functions)

SKILLS

Some of our [customers/clients/patients] may not speak English. Do you speak, write or understand any foreign language? *YesNo

If yes which language(s) and with what proficiency:

Are you able to operate a personal computer? *YesNo

Types of software

List other office machines you can operate: *

Specific skills or training: *

What knowledge, special skills and/or individual capabilities do you have which especially prepare you for the position applied for? *

EDUCATIONS

Type of SchoolHigh School or Trade SchoolBusiness or Tech SchoolJr College and /or UniversityOther Trainings

Name Of school

Location Of school

No of Years

Degree(s) or Diploma(s) *

Graduated ? *YesNo

Major Field(s) or Study *

Graduated If Yes

Graduated ?YesNo

Major Field(s) or Study

Graduated If Yes

EMPLOYMENT HISTORY

Experience: Please account for all employment within the last seven (7) years, beginning with your current or more recent employer. In addition, please indicate any other experience which you believe is relevant to the position for which you are applying (e.g., volunteer experience. military service, experience gained over seven (7) years prior, etc.) Attach an additional sheet if extra space is needed. *

Attach an additional sheet

No file chosen

Answer all of the following questions if you are applying far a professional licensed or certified position

Are you licensed/certified for the job you are applying for? *YesNo

Name of license/certification

Issuing state:

License certification number:

Has your license/certification ever been revoked or suspended? *YesNo

If yes, explain:

HTML

POSITIONS HELD

Company Name:

Dates Employed

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Starting Salary

Ending Salary

Telephone

Supervisor:

ls this your current employer? *YesNo

Job Title:

Hours Worked From

Hours

Minutes

Hours Worked to

Hours

Minutes

Specific Job Duties:

Reason for Leaving

May We Contact This Employer?YesNo

What is the most important skill(s) demonstrated on the job?

MILITARY SERVICE

Have you obtained and special skills or abilities as the result of service in the military?YesNo

If yes, please describe

HTML

PERSONAL REFERENCES

Please list at least two (2) persons NOT related to you who have known you for at least five (5) years.

Name

Street Address

Phone Number

Name

Street Address

Phone Number

Name

Street Address

Phone Number

Gender *MaleFemale

Do you have a felony? *

Save as Draft