318.346.9288
Home
postpostheader postpostheader postpostheader postpostheader postpostheader

Employment Center


Employment Center Information

Please Fill Out and Email To:
msliz4kidz@yahoo.com
Subject:Caretec Website





Care Tec Pediatric Center, LLC

855 Shirley Rd

Bunkie, LA 71322

318-346-9288 OFFICE 318-346-9269 FAX- 337-301-1029 CELL

           EMPLOYMENT APPLICATION
           
POSITION APPLIED FOR:_______________

            CELL PHONE:__________________            APPLICANT TELEPHONE:_______________

NAME:_____________________________________________________________________

            LAST                                                    FIRST                                       MIDDLE

ADDRESS:

________________________                                                            ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE USA?

________________________                                                                 YES         NO (IF YES VERIFICATION WILL BE REQUIRED)

________________________                                                            I AM SEEKING A PERMANENT POSITION: YES       NO

ARE YOU ABLE TO PERFORM THE ESSENTIAL FUNCTIONS                             IF NECESSARY, FOR THE JOB I AM ABLE TO:

OF THE POSITION WITH OR WITHOUT ACCOMODATIONS?                                WORK (WHICH SHIFTS)?               SELECT:___________      

                                                                                                                                      WORK OVERTIME?                         SELECT:___________      

                                                                                                                                      PROVIDE A VAILD DRIVER’S LICENSE?      SELECT:___________      

IF NECESSARY FOR THE JOB, ARE YOU OVER (PLEASE MARK ONE)   14__  15__  16__  18__  19__  21__

I WILL BE ABLE TO REPORT TO WORK ___ DAYS AFTER BEING NOTIFIED THAT I AM HIRED.

EDUCATION:

HIGH SCHOOL

YES COMPLETED

FIELD OF STUDY

GRADUATE OR DEGREE

 

 

 

COLLEGE/UNIVERSITY

 

 

 

BUSINESS/TECHNICAL

 

 

 

OTHER (MAY INCLUDE GRAMMAR SCHOOL)

 

 

 

MILITARY SERVICE:     YES    NO

DUTY/SPECIALIZED TRAINING:___________________________________________________________

 

REFERENCES: LIST TWO PERSONAL REFERENCES WHO ARE NOT RELATIVES OR FORMER SUPERVISORS.

_________________________________________________________________________________________________________

NAME                                  ADDRESS                                           TELEPHONE                   OCCUPATION                           YEARS KNOWN

_________________________________________________________________________________________________________

NAME                                  ADDRESS                                           TELEPHONE                   OCCUPATION                           YEARS KNOWN





EMPLOYMENT: LIST LAST EMPLOYMENT FIRST. INCLUDE SUMMER OR TEMPORARY JOBS. BE SURE ALL YOUR EXPERIENCE OR EMPLOYERS RELATED TO

THIS JOB ARE LISTED HERE, IN THE SUMMARY (FOLLOWING THIS SECTION) OR USE AN EXTRA SHEET OF PAPER IF NECESSARY.

EMPLOYER NAME AND ADDRESS:

POSITION TITLE/DUTIES SKILLS

DATES EMPLOYED

FROM                  TO

 

 

 

REASON FOR LEAVING

 

SUPERVISOR’S NAME: TELEPHONE

EMPLOYER NAME AND ADDRESS:

POSITION TITLE/DUTIES SKILLS

DATES EMPLOYED

FROM                  TO

 

 

:

REASON FOR LEAVING

 

SUPERVISOR’S NAME: TELEPHONE

EMPLOYER NAME AND ADDRESS:

POSITION TITLE/DUTIES SKILLS

DATES EMPLOYED

FROM                  TO

 

 

 

REASON FOR LEAVING

 

SUPERVISOR’S NAME: TELEPHONE

EMPLOYER NAME AND ADDRESS:

POSITION TITLE/DUTIES SKILLS

DATES EMPLOYED

FROM                  TO

 

 

 

REASON FOR LEAVING

 

SUPERVISOR’S NAME: TELEPHONE

 

SUMMARIZE OTHER EMPLOYMENT RELATED TO THIS JOB__________________________________________________

 


TYPES OF COMPUTERS, OTHER ELCTRONIC, OR MECHANICAL EQUIPMENT THAT YOU ARE QUALIFIED TO OPERATE OR REPAIR:__________________________________________________________________________________________

 


PROFESSIONAL LICENSES, CERTIFICATIONS OR REGISTRATIONS: _____________________________________________

 


ADDITIONAL SKILLS INCLUDING SUPERVISION SKILLS, OTHER LANGUAGES, OR INFORMATION REGARDING THE CAREER/OCCUPATION YOU WISH TO BRING TO THE EMPLOYER’S ATTENTION______________________________________________________________________________________

_______________________________________________________________________________________________________________________




Contact Us
 
Visit Us Explore Upcoming Events
Care Tec Pediatric Center, LLC
855 Shirley Rd
Bunkie, LA 71322


Phone: 318.346.9288
             888.948.3162
Fax: 318.346.9269
Email: msliz4kidz@yahoo.com
Home
Get a Quote
Customer Service
Glossary
About Us
Contact Us
Blog
Locations
Go with an independent insurance agent! Saving money can be easy!
Powered by Insurance Website Design