AmeriCare Online Employment Application

ONLINE EMPLOYMENT APPLICATION <

OUR SERVICES

Skilled Nursing
Physical Therapy
Occupational Therapy
Speech Therapy
Social Worker
Home Health Aide
SPECIALTY PROGRAMS
H.E.A.R.T. Cardio-thoracic Post-operative Program
Total Joint Replacement Program
Living With Congestive Heart Failure
Diabetes Education

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DATE:

Position(s) Applied For:

Expected salary/hourly rate:

How did you learn about us?:

PERSONAL INFORMATION

Last Name:

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First Name:

* required

Middle Initial:

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Address:

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City:

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State:

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Zip Code:

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Phone(s):

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Email:

How Long:

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Previous Address:

Do you have a valid Florida Driver's License?:

Have you ever been employed with us before?:

If yes, give date:

Are you currently Employed?:
May we contact your present employer?:

On what date would you be available for work?:

Are you available to work?
To make multiple choices: Hold down Ctrl button and then click on choices.

Are you prevented from lawfully becoming employed in this country?:
*Proof of citizenship or status will be required upon employment

Are you capable of performing in a reasonable manner the activities involved in the job or occupations for which you have applied?:

Have you ever been convicted of a felony or had adjudication withheld?:

Conviction will not necessarily disqualify an applicant from employment. If yes, please explain

EMPLOYMENT EXPERIENCE
PLEASE START WITH YOUR CURRENT OR MOST RECENT JOB

Employer:

Dates employed:

From:

To:

Address:

Telephone Number:

Job Title:

Salary:

Starting:

Final:

Supervisor:

Work Preformed:

Employer:

Dates employed:

From:

To:

Address:

Telephone Number:

Job Title:

Salary:

Starting:

Final:

Supervisor:

Work Preformed:

Employer:

Dates employed:

From:

To:

Address:

Telephone Number:

Job Title:

Salary:

Starting:

Final:

Supervisor:

Work Preformed:

REFERENCES
PLEASE LIST TWO

Name:

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Telephone:

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Years Known:

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Name:

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Telephone:

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Years Known:

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We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation or any other legally protected status. Equal access to programs, services, and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

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