Careers

Do you have a passion for taking care of others, even those unrelated to you? Land your dream job with us! We are looking for qualified care professionals who could join our team. If you are interested, you may send your resume using the form below.

First Name

Last Name

Middle

Other Surnames Used in the Past

Present Street Address

City

State

Zip

Permanent Street Address (if different)

City

State

Zip

Home Phone #

Alternate Phone #

How did you hear about this position?

Referred By:

Are you legally entitled to work in the United States?

Are you at least 18 years of age?

In case of emergency, notify:

Phone Number

Relationship

US Military Service?

Military Rank

Present Membership in National Guard or Reserves?

Employment Position Desired

Have you passed Competency Training?

Do you have a Competency Training Certificate?

Do you have a current driver's license?

Do you currently have a car?

Have you ever applied to this company before?

If you have previously applied, where and when?

Do you have any professional licenses, certifications, and/or registrations?

Give below the names of three work-related references.

Reference #1 Name

Reference #1 Address

Reference #1 Company / Position

Reference #1 Phone

Reference #2 Name

Reference #2 Address

Reference #2 Company / Position

Reference #2 Phone

Reference #3 Name

Reference #3 Address

Reference #3 Company / Position

Reference #3 Phone

Education Fill out whatever is necessary

High School

Years Attended

Graduated

Degree / Certification

College 1

Years Attended

Graduated

Degree / Certification

College 2

Years Attended

Graduated

Degree / Certification

Additional Training

Years Attended

Graduated

Degree / Certification

Former Employers

List below your complete employment history for the last five years, starting with the most recent position first.

Former Employers

Authorization

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for rejection or dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time, with or without cause, and with or without any prior notice. I acknowledge that the date on which this form is completed shall serve as the official date of execution for all legal and administrative purposes.

Digital Signature

Voluntary Self-Identification Information

ASSURED WELLNESS LLC is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to sex, race, color, national origin or ancestry, age, handicap, marital status, source of income, class, physical characteristics, sexual orientation or political beliefs.

As an employer, we comply with government regulations and affirmative action responsibilities. Solely to help us comply with government record keeping, reporting and other legal requirements, please complete this Voluntary Self-Identification Information form. This data is for analysis and affirmative action only and submission of this information is voluntary. This data will be kept in a confidential file separate from your Application for Employment.

Gender

Veteran Status

Race / Ethnic Background

Disability Status

According to the American with Disabilities Act, the term “disability” means, with respect to an individual, a physical or mental impairment that substantially limits one or more of the major life activities of that individual, a record of such an impairment, or being regarded as having such an impairment.

Careers

Former Employers

Voluntary Self-Identification Information

Contact Assured Wellness