Quick Job App

First Name

Last Name

Email

Phone

Address

City

State

Zip Code

How did you hear about LifeScape?

Are you 18 years old? Yes No

Do you have a high school diploma/GED? Yes No

Do you have a valid driver's license? Yes No

Did someone refer you? Yes No

If yes, who referred you?

Have you been employed by LifeScape before? Yes No

Can you provide documents to legally work in the U.S.? Yes No

Have you ever been convicted of a felony? Yes No

If yes, please describe your conviction.

What is your highest level of education?

What job are you applying for?

Are you interested in a full-time or part-time position?

Can you work holidays/weekends? Yes No

Are you willing to work overtime? Yes No

What is your current or last place of employment?

Briefly describe your responsibilities.

What dates did you start and end employment at your last place of employment?

What was the first and last name of your supervisor at your last place of employment?

May we contact your supervisor as a reference?

If yes to previous question, what is the appropriate phone number to call?