EMPLOYMENT APPLICATION

The First Step to Joining the Team!

Applicant Basic Information

Tell us a little about yourself, and how we can contact you!

Name

First Name

Last Name

Phone

(###)

###

####

Email Address

Are you at least 18 years of age?

Have you previously applied for a position with ILC?

Education

Tell us about your previous and current educational pursuits

Have you received your High School Diploma, GED, or equivalent?

Name of High School or equivalent

Please list name and address

Dates Attended

Have you attended, or are you currently attending, a higher education institution?

(*optional and not required, skip if not applicable*) A higher education institution includes a certification program, technical college, university, or other continuing education program attended after high school

Name of Educational Institution

Please list name and address

Field of study

Dates Attended

Did you graduate?

Are you a member or veteran of the armed services?

ILC, LLC is proud to be partially Veteran owned and operated; we take great pride in providing fellow Veterans employment opportunities and continuing to serve our fellow Veteran residents in our care..

Which position are you applying for?

I currently live in the City, Town or Village of:

State of:

Previous Experience

Not all caregivers are paid! If you have previous experience caring for individuals with disabilities, we'd love to hear about it! Previous experience may include personal experience, volunteering, or a work experience not listed above. If you don't have previous experience, never fear! We are happy to train the right candidate!

Do you have previous experience working with individuals with disabilities?

If yes, please explain

Do you have any training or certification you feel would help you as an employee of ILC?

Related training or certification may include, but is not limited to: CNA Certification, First Aid, CPR/AED, Medication Administration, or Fire Safety

If yes, list your related training or certification

Background Information

ILC does not discriminate based on criminal history. We believe everyone who is willing and able to work has the right to gainful employment. However, certain substantially related offenses may prohibit an individual from working in this field.

Background Check Disclaimer

I understand that, if I am offered a position, the hiring action is not complete until ILC completes and approves a criminal background check for each state I have lived in for the past three years.

I Agree

I Disagree

By signing below, I certify that the information contained in this application is complete and accurate to the best of my knowledge. I understand that to falsify or omit information is grounds for refusing to hire me; or if I am hired, is cause for immediate termination of my employment. I authorize any person, organization or company listed on this application to furnish ILC any and all information concerning my previous employment, education and qualifications for employment. I also authorize ILC to request and receive such information. In consideration for my employment, I agree to abide by the rules and regulations of ILC, and I acknowledge such rules may be changed, withdrawn, added or interpreted at any time, at ILC’s sole discretion and without prior notice to me. I understand that, upon hire, my employment is subject to the conditions of employment set forth and required by federal and state licensing and regulatory agencies.

Date

YYYY

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