Employment Application

Application for Employment - Step 1 of 2

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Confirm Email

I am applying for the following position *

Direct Service Provider
Other

If Other, please specify

If you chose the "Other" option, please specify the position you are applying for.

Availability *

Full Time
Part Time
Temporary

Check all that apply

Date available to start *

Are you at least 18 years of age?

Have you ever been employed here?

Are you legally eligible to work in the U.S.? *

Proof of U.S. citizenship or immigration status/work authorization will be required upon employment

Do You have a valid driver's license? *

Do you currently have criminal proceedings pending in any court? *

If Yes, please explain.

The existence of a conviction or pending charge will not necessarily preclude you from employment.

Have you been convicted/pled guilty to, pled no contest to, or admitted to any felony crime, including but not limited to, sex-related or child abuse-related offenses? *

If Yes, please explain.

The existence of a conviction or pending charge will not necessarily preclude you from employment.

Have you ever been discharged from a job or forced to resign? *

If Yes, please explain

If you answered yes to the question above, please explain.

May we contact your present employer? *

Name of person to contact

Please enter the contact person at your present employer.

Phone number of person to contact

Were you referred by a current employee?

Who referred you?

End of Step One

Please click the button when you are ready to continue to the next section.

Education, References, and Employment History

Choose whether you will upload a resume or enter education and employment history online.

I will complete this application by: *

Uploading or Sharing my Resume
Entering my work history/education manually

Resume Upload option

Drag & Drop Files, Choose Files to Upload

Upload your resume as a PDF or DOC file.

Resume Share option

Copy then paste the share link here. Be sure to include the entire link (e.g: https://indeed.com/myresumelink...)

Employment Section

Please fill in all fields. To add additional employers, click the box when prompted.

Current or Most Recent Employer

Name of Company

Job Title/Position

Name of Supervisor

Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

From Date

To Date

Reason for Leaving

Additional employer

Add another employer

Click the check box to add an additional employer to your employment history

Previous Employer 1

Name of Company 2

Job Title/Position 2

Name of Supervisor 2

Phone Number 2

Address 2

Address Line 1

Address Line 2

City

State

Zip Code

From Date 2

To Date 2

Reason for Leaving 2

Add Additional Employer 2

Add Another Employer

Click the check box to add an additional employer to your employment history

Previous Employer 2

Name of Company 3

Job Title/Position 3

Name of Supervisor 3

Phone Number 3

Address 3

Address Line 1

Address Line 2

City

State

Zip Code

From Date 3

To Date 3

Reason for Leaving 3

Education Section

Please enter the following information about Schools you have attended.

Name of School

Area of Study

Graduated?

Location of School

Diploma/Degree Earned

Additional School

Add Additional School

Click the check box to add an additional educational institution to your application.

School Number 2

Name of School 2

Area of Study 2

Graduated from School 2?

Location of School 2

Diploma/Degree Earned 2

Additional School - 2

Add Additional School

Click the check box to add an additional educational institution to your application.

School Number 3

Name of School 3

Area of Study 3

Graduated from School 3?

Location of School 3

Diploma/Degree Earned 3

References Section

Please provide at least two professional or personal references. Additional refernces can added by checking the box when prompted. This is a required field.

Reference Number 1*

Name of Reference *

Occupation/Title *

Relationship to you *

Phone Number *

Reference Number 2*

Name of Reference 2 *

Occupation/Title 2 *

Relationship to you 2 *

Phone Number 2 *

Add Reference

Add Another Reference

Click the check box to add an additional personal or professional reference.

Reference Number 3

Name of Reference 3

Occupation/Title 3

Relationship to you 3

Phone Number 3

Add Reference 2

Add Another Reference

Click the check box to add an additional personal or professional reference.

Reference Number 4

Name of Reference 4

Occupation/Title 4

Relationship to you 4

Phone Number 4

Additional Information

Tell us a bit about you

Submit Your Application

Once you have read the terms for application of employment, click the Submit button. Depending on the size of any attachments it may take several moments before a confirmation message appears. In the mean time, do not exit the browser window. Once your application has been submitted, a confirmation message will appear.

Terms of Application for Employment *

I have read and agree to the terms of application for employment

I consent to having this website store my submitted information so that Innovative Health Care Concepts, Inc. can evaluate my application for employment. Please check our privacy policy to see how we manage your submitted data.
I hereby state that the information given by me in this application is true in all respects. I agree that if I am employed and the information is found to be false in any respect, I will be subject to dismissal without notice at any time. I hereby authorize my former employers to release information pertaining to my work record, my work habit, and my work performances while in their employ.
In making application for employment, I understand that an investigative report may be made by a consumer reporting agency to include information as to my general character, general reputation, personal characteristics and mode of living, whichever may be applicable. If such an investigative report is made, I understand that I will receive notice that such a report has been requested and that I will have the right to make written request for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation.
I understand and agree that any employee handbook which I may receive will not constitute an employment contract, but will be merely a gratuitous statement of the company’s current policies.

I UNDERSTAND AND AGREE THAT IF I AM OFFERED EMPLOYMENT BY INNOVATIVE HEALTH CARE CONCEPTS, INC., MY EMPLOYMENT WILL BE FOR NO DEFINITE TERM AND THAT EITHER I OR IHCC WILL HAVE THE RIGHT TO TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE. I ALSO UNDERSTAND THAT THIS STATUS CAN ONLY BE ALTERED BY WRITTEN CONTRACT OF EMPLOYMENT WHICH IS SPECIFIC TO ALL MATERIAL TERMS AND IS SIGNED BY ME AND THE ADMINISTRATOR OF INNOVATIVE HEALTH CARE CONCEPTS, INC.

AN EQUAL OPPORTUNITY EMPLOYER

It is the policy of Innovative Health Care Concepts to provide equal opportunities without regard to race, color, religion, sex, national origin, age or handicap.

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