Please enable JavaScript in your browser to complete this form.Application for Employment - Step 1 of 2Name *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *EmailConfirm EmailI am applying for the following position *Direct Service ProviderOtherIf Other, please specifyIf you chose the "Other" option, please specify the position you are applying for.Availability *Full TimePart TimeTemporaryCheck all that applyDate available to start *Are you at least 18 years of age?YesNoHave you ever been employed here?YesNoAre you legally eligible to work in the U.S.? *YesNoProof of U.S. citizenship or immigration status/work authorization will be required upon employmentDo You have a valid driver's license? *YesNoDo you currently have criminal proceedings pending in any court? *YesNoIf Yes, please explain.The existence of a conviction or pending charge will not necessarily preclude you from employment.Have you been convicted of a felony in the last five (5) years? *YesNoIf 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? *YesNoIf Yes, please explainIf you answered yes to the question above, please explain.May we contact your present employer? *YesNoName of person to contactPlease enter the contact person at your present employer.Phone number of person to contactWere you referred by a current employee?YesNoWho referred you?End of Step OnePlease click the button when you are ready to continue to the next section.Go to Step TwoEducation, References, and Employment HistoryChoose whether you will upload a resume or enter education and employment history online.I will complete this application by: *Uploading or Sharing my ResumeEntering my work history/education manuallyResume Upload option Click or drag a file to this area to upload. Upload your resume as a PDF or DOC file.Resume Share optionIf your resume is in the cloud (e.g: Google Docs) paste the share link here.Employment SectionPlease fill in all fields. To add additional employers, click the box when prompted.Current or Most Recent EmployerName of CompanyJob Title/PositionName of SupervisorPhone NumberAddressAddress Line 1Address Line 2CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFrom DateTo DateReason for LeavingAdditional employerAdd another employerClick the check box to add an additional employer to your employment historyPrevious Employer 1Name of Company 2Job Title/Position 2Name of Supervisor 2Phone Number 2Address 2Address Line 1Address Line 2CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFrom Date 2To Date 2Reason for Leaving 2Add Additional Employer 2Add Another EmployerClick the check box to add an additional employer to your employment historyPrevious Employer 2Name of Company 3Job Title/Position 3Name of Supervisor 3Phone Number 3Address 3Address Line 1Address Line 2CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFrom Date 3To Date 3Reason for Leaving 3Education SectionPlease enter the following information about Schools you have attended.Name of SchoolArea of StudyGraduated?YesNoLocation of SchoolDiploma/Degree EarnedAdditional SchoolAdd Additional SchoolClick the check box to add an additional educational institution to your application.School Number 2Name of School 2Area of Study 2Graduated from School 2?YesNoLocation of School 2Diploma/Degree Earned 2Additional School - 2Add Additional SchoolClick the check box to add an additional educational institution to your application.School Number 3Name of School 3Area of Study 3Graduated from School 3?YesNoLocation of School 3Diploma/Degree Earned 3References SectionPlease 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 ReferenceAdd Another ReferenceClick the check box to add an additional personal or professional reference.Reference Number 3Name of Reference 3Occupation/Title 3Relationship to you 3Phone Number 3Add Reference 2Add Another ReferenceClick the check box to add an additional personal or professional reference.Reference Number 4Name of Reference 4Occupation/Title 4Relationship to you 4Phone Number 4Additional InformationTell us a bit about youSubmit Your ApplicationOnce 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 employmentI 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 EMPLOYERIt is the policy of Innovative Health Care Concepts to provide equal opportunities without regard to race, color, religion, sex, national origin, age or handicap.Back to Step OneNameSubmit your Application