Employment Application

Employment Application

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Employment History

1) Current Employer


2) Previous Employer


3) Previous Employer


4) Previous Employer


Personal Information

Available To Start Work

What Shifts Are You Able to Work?

Shift Preference

Are You Legally Authorized to Work in The U.S.?

What Type of Work Are You Applying For?

How Were You Referred?

Do You Have Any Relatives Employed at CompleteCare?

Have You Ever Been Employeed By CompleteCare?

If Yes, From
If Yes, To

Are You 18 Years of Age or Older?

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Educational Records

Professional Credentials/Licenses/Certifications

Knowledge of Medical Terms?

Has Your License Ever Been Revoked?

Professional References

Your Resume


I understand that this application is intended for informational purposes only. If offered employment, I understand that I will be employed “at will.” This means that I have the right to quit my job at any time and for any reason I deem appropriate, unless otherwise stated in a signed contract provided by Community Health Care, Inc. Likewise, Community Health Care, Inc. may terminate the employment relationship, or change wages, benefits or working conditions, at any time and for any reason. While I may receive salary increases, favorable performance evaluations, commendations, bonuses, promotions and the like, my “at will” status will not change. (I understand that no change in my “at will” status, and any promise or guarantee of employment, shall occur unless the promise of guarantee is clearly stated in a written contract signed by me and an authorized Community Health Care, Inc. officer).

I understand that Community Health Care, Inc. is an equal opportunity employer and is committed to hiring an employee without regard to race, creed, color, ancestry, marital status, affectional or sexual orientation, religion, sex, age, national origin, disability, smoking status, Vietnam-era, disabled or other eligible veteran or any other basis prohibited by applicable law.

If employed, I authorize Community Health Care,Inc. upon termination of employment, to provide reference about my work and I hereby release Community Health Care, Inc., its officers, directors, agents, and employees from any and all liability from the provision of such reference information.