Call Us

Main Office Number
(561)664-8074

Email Us

[email protected]

Our Address

4364 Forest Hill Blvd, West Palm Beach FL 33406

Call Us

Main Office Number
(561)664-8074

Call Us

After Hours
(561)781-0074

Email Us

[email protected]

Our Address

4364 Forest Hill Blvd, West Palm Beach FL 33406

Book An Appointment
Book An Appointment

Call Us

(561)781-0074

Email Us

[email protected]

Our Address

4364 Forest Hill Blvd, West Palm Beach FL 33406

Book An Appointment

Application for Employment

PERSONAL INFORMATION

Name
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Address
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Do you have a High School Diploma or GED?
If Employed, may we inquire of your current employer?

POSITION INFORMATION

Preferred Shift
Preferred Hours
Swing
Status
Are you authorized to work in the U.S. on an unrestricted basis?
Have you ever been convicted of a felony?
Licensed Profession:
Can you perform these essential functions of the job with or without reasonable accommodation?

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QUALIFICATIONS

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.
Address
Address
Address
Do you have any physical disabilities that would prevent you from performing the work for which you are applying?

PERSONAL REFERENCES

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references.
Name
Address
Name
Address
Name
Address

WORK HISTORY

Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS)
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Supervisor’s Name
Address
May we contact your present employer?
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Supervisor’s Name
Address
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Supervisor’s Name
Address

Emergency Contact

Name
Address
Name
Address
Name
Address
I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application. I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.
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LCFmed Healthcare Staffing revolutionizes home health, delivering skilled professionals, personalized care, and a concierge approach to your doorstep.

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