Apply | Loving Hearts and Hands

Apply to Loving Hearts and Hands

Loving Hearts & Hands Health Agency is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

To apply, please complete the application by filling out the fields below:

Applicant Information

First Name

Phone Number

Last Name

Email Address

Street Address

Street Address Line 2

City

State

Zip Code

Employment Position

Position you are applying for

What days are you available for work?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Available Start Date

Desired Salary

Personal Information

If yes, when?

If yes, state their name and relationship

What document can you provide as proof of citizenship or legal status?

If yes, please describe accommodations required

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Education and Training

High School Name

City

Graduation Year

State

College School Name

City

Graduation Year

State

Vocational School / Specialized Training

City

Graduation Year

State

If yes, what branch of the military did you enlist?

If yes, what was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying:

(Note: Loving Hearts & Hands Health Agency complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)

Previous Employment

Employer 01 Name:

Job Title:

Supervisor's Name:

Street Address

City

State

Zip Code

Employer's Phone Number

Start Date:

End Date / Currently Employeed?

Reason for leaving:

Employer 02 Name:

Job Title:

Supervisor's Name:

Street Address

City

State

Zip Code

Employer's Phone Number

Start Date:

End Date / Currently Employeed?

Reason for leaving:

Employer 03 Name:

Job Title:

Supervisor's Name:

Street Address

City

State

Zip Code

Employer's Phone Number

Start Date:

End Date / Currently Employeed?

Reason for leaving:

Professional References

Reference 01

Reference 02

Contact Information:

At-Will Employment

The relationship between you and the Loving Hearts & Hands Health Agency is referred to as

"employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Loving Hearts & Hands Health Agency. No representative of Loving Hearts & Hands Health Agency has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

Applicant Resume

Upload Resume (PDF)

Digital Signature

Applicant Signature (Type Full Name):

Thank You for Applying!

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