Career Application Form

Help us identify your areas of interest by selecting from the following:
Please tell us what field you are looking for?* What position are you applying for?*
 


Contact/Personal Information
First Name * Last Name * MI E-mail*
Cell Phone Primary Phone Alternate Phone
Please provide the best way to contact you. * Phone

Current Address
Street Address* City* State/Province* Zip*

How long have you lived at this address? * Less than 5 years   More than 5 years

Is this address your permanent address? * Yes   No

How did you hear about us?
How did you learn of Life Wellness Home Health Agency? *
Advertisement   Internet   Employment Agency   Health Care Employee   Other

if other, please specify:

Eligibility
Are you 18 years of age or older? * Yes   No

If hired, can you provide proof of legal age? * Yes   No

If hired, will you be able to furnish proof of your legal right to reside and work in the United States? * Yes   No

If an employment opportunity is offered you will be asked to show proof of: identification, reliable transportation, an up-to-date physical exam, current CPR certification and TB test; and two work references within the healthcare field. Will you be able to provide all of this information? * Yes   No