Careers

Employment Application

This is the LifeSpring Inc. Application for Employment. All candidates for employment must complete an application prior to being considered for a position. You are required to submit an application even if you submit your resume.

Date available for work*
Date Format: MM slash DD slash YYYY
What is your desired salary range?_________*
Are you available to work:*
- Full-Time
- Part-Time
- Temporary
Indicate which shifts and/or hours you are available.*
Are you currently on “lay-off” status and subject to recall?*
- Yes
- No
Can you travel if a job requires it?*
- Yes
- No
Have you been convicted of a felony within the last five years?*
- Yes
- No
A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.

Education
Elementary School*
Name and Address of School, Course of Study, Number of Years Completed, Diploma Degree*
High School*
Name and Address of School, Course of Study, Number of Years Completed, Diploma Degree*
Undergraduate College*
Name and Address of School, Course of Study, Number of Years Completed, Diploma Degree*
Graduate Education*
Name and Address of School, Course of Study, Number of Years Completed, Diploma Degree*
Other (Specify)
Name and Address of School, Course of Study, Number of Years Completed, Diploma Degree*
Describe any specialized training, apprenticeship, skills and extra-curricular activities.*
Describe any job-related training received in the United States military.*

EMPLOYMENT EXPERIENCE
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.
Employer One
Employer One Name:*
Employer One Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title*
Supervisor*
Reason for leaving*
Employed Dates:*
Please use this format 03/10/2010 - 03/10/2012
Work Performed*
Starting Salary*
Ending Salary*
Employer Two
Employer Two Name*
Employer Two Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title*
Supervisor*
Reason for Leaving*
Employed Dates:*
Please use this format 03/10/2010 - 03/10/2012
Work Performed*
Starting Salary*
Ending Salary*

Employer Three
Employer Three Name*
Employer Three Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title*
Supervisor*
Reason for Leaving*
Employed Dates:*
Please use this format 03/10/2010 - 03/10/2012
Work Performed*
Starting Salary*
Ending Salary*
Employer Four
Employer Four Name*
Employer Four Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title*
Supervisor*
Reason for Leaving*
Employed Dates:*
Please use this format 03/10/2010 - 03/10/2012
Work Performed*
Starting Salary*
Ending Salary*

REFERENCES
Reference One Name*
First Last
Reference One Phone*
Reference One Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference Two Name*
First Last
Reference Two Phone*
Reference Two Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference Three Name*
First Last
Reference Three Phone*
Reference Three Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time, and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Applicant's Statement*
I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time, and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
- Yes
AGREEMENT, AUTHORIZATION, AND CONSENT FOR RELEASE OF BACKGROUND INFORMATION
In order to proceed with the hiring process, all successful applicants must agree to a background check, including driving record, criminal history, personal and professional, and other work-related areas. Please fill out the AGREEMENT, AUTHORIZATION, AND CONSENT FOR RELEASE OF BACKGROUND INFORMATION form and (1) fill it out (2) print it (3) scan and upload below under "AGREEMENT". You must have Adobe Acrobat in order to download and print the form. You can find the form at: http://www.lifespringhealthsystems.org/wp-content/uploads/Background-Check.pdf
AGREEMENT
Accepted file types: pdf, gif, png, jpg.
Please note, you MUST HAVE THE ADOBE ACROBAT READER SOFTWARE TO DOWNLOAD the above agreement. Once downloaded, you can fill it out, sign it and scan it in to your computer and attach it to your application. Acceptable file extensions are PDF, JPG, PNG, GIF
Resume Submission
Accepted file types: pdf, doc, jpg, gif, png, txt, wps, rtf, docx, wpd, png.
If you would like to submit your resume, please attach. ADOBE files (with PDF file extensions are preferred. However, we will also accept the following file extensions: DOC, JPG, GIF, PNG, TXT, WPS, RTF, DOCX, PNG.

Careers

Employment Application

Step 1 of 7

Education

EMPLOYMENT EXPERIENCE

Employer One

Employer Two

Employer Three

Employer Four

REFERENCES

AGREEMENT, AUTHORIZATION, AND CONSENT FOR RELEASE OF BACKGROUND INFORMATION

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