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London Women’s Care, PLLC is an equal opportunity employer and does not discriminate against applicants or employees on the basis of sex, race, color, religion, national origin, ancestry, or age (40 years of age or older). In addition, the company does not discriminate against qualified individuals with disabilities.

By submitting this application, you certify that all information contained in the application is true and complete and acknowledge that the company is relying on the accuracy of the information provided. You authorize the company the verify the accuracy of the information provided and authorize former employers, educational institutions and credit agencies to release information concerning you to the company. You also authorize the company to give references and provide information about you in response to inquiries subsequent to your employment if hired. You understand that falsification, misrepresentation or omission or requested information may result in denial of employment or, if employed, may result in immediate dismissal. You understand and agree that, if hired, your employment will be for no definite period and may, regardless of the date of payment of wages, be terminated at any time without previous notice and with or without reason, at the will of either yourself or the company.

Online Application

Full Name (required)

Email Address (required)

Phone (required)

Address (required)

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State (required)

ZIP Code (required)

How long at this address? (required)

Are you at least 18 years of age?
YesNo

If under 18, please list age

Desired Position

Desired Salary (required)

Days available to work
SundayMondayTuesdayWednesdayThursdayFridaySaturday

How many hours can you work weekly? (required)

Employment Desired? (required)
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When can you start? (required)

Education (select all that apply)
High School GraduateGEDCollege Graduate

List schools attended (required)

Have you ever been convicted of a felony? (required)

If yes, please explain the number of convictions, nature of offense(s) leading to those convictions, the dates the offense(s) were comitted, sentence(s) imposed, and the type(s) of rehabilitation

Do you have a valid driver's license? (required)

What is your means of transportation to work? (required)

Driver's License Number (required)

Driver's License Expiration (required)

Driver's License State of Issue (required)

Type of Driver's License
OperatorCommercial CDLChauffeur

Have you had any auto accidents in the last 3 years? (required)

If yes, how many?

Have you had any moving traffic violations in the past 3 years? (required)

Reference #1 Name (required)

Reference #1 Title (required)

Reference #1 Employer (required)

Reference #1 Telephone (required)

Reference #2 Name (required)

Reference #2 Title (required)

Reference #2 Employer (required)

Reference #2 Telephone (required)

Have you ever served in the armed forces? (required)

Are you currently a member of the National Guard? (required)

Previous Employer #1 Company Name (required)

Previous Employer #1 Address (required)

Previous Employer #1 Phone (required)

Previous Employer #1 Supervisor Name (required)

Previous Employer #1 Employment Start Date (required)

Previous Employer #1 Employment End Date (required)

Previous Employer #1 Salary (required)

Previous Employer #1 Job Title (required)

Previous Employer #1 Reason for Leaving (required)

Previous Employer #2 Company Name (required)

Previous Employer #2 Address (required)

Previous Employer #2 Phone (required)

Previous Employer #2 Supervisor Name (required)

Previous Employer #2 Employment Start Date (required)

Previous Employer #2 Employment End Date (required)

Previous Employer #2 Salary (required)

Previous Employer #2 Job Title (required)

Previous Employer #2 Reason for Leaving (required)

May we contact your current employer? (required)

Please list your professional license number (required)

Professional license number expiration date (required)

Professional license type (required)

Please list any additional training or certifications you may have

Required fields are noted above. If a question doesn’t apply, please put N/A and do not leave anything blank.