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______________________________________________________________________________________
_______________________________________________________________________________________________________________________
|