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APPLY FOR EMPLOYMENT

APPLICANT INFORMATION

First Name

Last Name

Address

Email

Phone

Date of Birth

EMPLOYMENT POSITION

Position(s) applying for:

How did you hear about this position?

What days are you available to work?

What hours or shift(s) are you available fo work?

If needed, are you available to work overtime?

YES

NO

Do you have realiable transportation to and from work?

YES

NO

If hired, what date could you start working?

What is your desired salary?

PERSONAL INFORMATION

Have you eve applied to or worked for One Life LLC. before?

YES

NO

Do you have any friends, relatives or acquaintances working for One Life LLC?

YES

NO

If yes, when?

If yes, state name and your relationship.

Are you 18 year of age or older?

YES

NO

Are you a U.S. Citizen or approved to work in the United States?

YES

NO

What document(s) can you provide as proof of citizenship or legal status?

Driver's License

Birth Certificate

Social Security Card

State Identification

Will you consent to a mandatory controlled substance test?

YES

NO

Do you require any job accomendations due to any illness, injury or diagnosis?

YES

NO

If yes, please describe accomendations required below.

Have you ever been convicted of a criminal offense (felony or misdemeanor)

YES

NO

If yes, please state the nature of the crime(s), when and where and disposition of the case.

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

JOB SKILLS / QUALIFICATIONS

Please list below the skills and qualifications you possess for the position for which your are applying:

Do you have any experience wth IDD?

YES

NO

Do you have any experience with elderly care?

YES

NO

Do you have a valid Driver's License?

YES

NO

Do you have active auto insurance?

YES

NO

EDUCATION

HIGH SCHOOL

Name

Year Graduated

Location (City, State)

Degree Earned

COLLEGE / UNIVERSITY

Name

Year Graduated

Location (City, State)

Degree Earned

VOCATIONAL SCHOOL / SPECIALIZED TRAINING

Name

Year Graduated

Location (City, State)

Degree Earned

MILITARY

Are you a member of the Armed Services?

YES

NO

If yes, what branch of the military did you enlist?

If yes, what was your military rank when discharged?

If yes, how many years did you serve in the military?

If yes, what military skills do you possess that would be an asset for this position?

PREVIOUS EMPLOYMENT

1. Employer Name

Employer Phone Number

Dates Employed

Job Title

Employer Address (City, State)

Reason for leaving (if applicable)

2. Employer Name

Employer Phone Number

Dates Employed

Job Title

Employer Address (City, State)

Reason for leaving (if applicable)

3. Employer Name

Employer Phone Number

Dates Employed

Job Title

Employer Address (City, State)

Reason for leaving (if applicable)

REFERENCES

PLEASE PROVIDE 3 PERSONAL / PROFESSIONAL REFERENCES BELOW:

Name / Relationship

Contact Information

Name / Relationship

Name / Relationship

Contact Information

Contact Information

AT-WILL EMPLOYMENT

The relationship between you and the One Life LLC is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the One Life LLC . No representative of One Life LLC has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

I understand the relationship is referred to as "employment at-will".

APPLICANT CERTIFICATION

I certify that the information provided in this Employment Application is true and correct to the best of my knowledge as of the date set forth below. I acknowledge that the Employer, ONE LIFE LLC. shall rely on the information contained herein and I authorize the employer to verify any or all information provided.

Sign Your Name

Thank you for your application.

A representative from our team will be in contact with you.

BUSINESS HOURS

MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY

8:30 A.M. - 4:30 P.M.
8:30 A.M. - 4:30 P.M.
8:30 A.M. - 4:30 P.M.
8:30 A.M. - 4:30 P.M.
8:30 A.M. - 4:30 P.M.
CLOSED
CLOSED

CONTACT INFORMATION

onelifellc19@gmail.com

(615) 647-7018

(615) 647-7019

801 E. OLD HICKORY BLVD. SUITE 130
MADISON, TN 37115

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