Application for Employment

Application for Employment
All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, medical condition, military/veteran status, genetic information, marital status, ethnicity, citizenship or immigration status or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative.

Your Information

Employment Experience

Please list the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references. Add additional page if necessary. [7 Years Minimum – 10 Years Maximum]

Employment Experience 1

May we contact?

Employment Experience 2

May we contact?

Employment Experience 3

May we contact?
If you need to convey further work experience, please upload a separate page in the file upload section below.
Have you ever been involuntarily terminated or asked to resign from any job?


Please describe your educational background

High School

Diploma / Degree


Diploma / Degree

Graduate/Professional School

Diploma / Degree

Trade School

Diploma / Degree


Diploma / Degree

Business and Professional References

Personal References

General Information

Have you ever used another name?
Is any additional information relative to name changes, use of an assumed name, or nickname, necessary to enable a check on your work or education record?
Have you ever worked for this Company "Life Inc" before?
Do you have friends and/or relatives working for this company?

Hours available to work

Are you available to work?
If hired, would you have a reliable means of transportation to work?
Can you travel within the program area if the position requires it?
Are you at least 21 years old?
If hired, can you present evidence of your identity and legal right to work in this country?
Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodation?
Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.

For Driving Positions

Do you have a valid Maryland Drivers License?
Do you have more than 2 points on your driving record?

Applicant Statement and Agreement

Please read and initial each paragraph below. If there is anything that you do not understand, please ask.
I hereby authorize the Company “LIFE Inc” to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company “LIFE Inc” any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
LIFE Inc promotes and supports a drug free environment. Per our substance Abuse and Testing Policy the agency requires all prospective employee to complete a PRE- EMPLOYMENT DRUG SCREEN. Applicant will have 24 hours to complete the DRUG SCREEN upon request. Failure to meet the 24-hour deadline, will result in rescission of the offer of employment.
LIFE Inc is forbidden by law from employing any individual who has a criminal history which would indicate behavior potentially harmful to program participants. Typically, applicants whose criminal history shows the following convictions: felony of a violent nature, violence against another person, abuse or neglect of child or an adult, sexual misconduct, gross irresponsibility or disregard for the safety of others and serious violations of accepted standards of honesty or ethical behavior, may not be considered for hire for direct support positions [employees who have direct contact with program participants]. Any applicant or employee who fails to disclose a criminal conviction or outstanding criminal charge on his/her application shall not be considered for employment or will be subject to separation of employment.
All direct care professional must be able to obtain and maintain MEDICATION TECHNICIAN CERTIFICATION. This is an essential job function. MEDICATION TECHNICIAN CERTIFICATION candidates must pass reading and math test, are screened for felonies and misdemeanors and must disclose any disciplinary actions from any state board or state agency.
Do you have any disciplinary actions from any state board of state agency?
In the event of my employment with the Company “LIFE Inc”, I understand that I am required to comply with all rules and regulations of the Company.
If hired, I understand and agree that my employment with the Company “LIFE Inc” is at-will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company “LIFE Inc” or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.
I understand that safety of employees is extremely important to the Company “LIFE Inc” and that the Company “LIFE Inc” is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.
I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.
I understand that successfully passing all pre-employment testing is a condition of employment. [drug test, physical, TB testing, and background check]. I consent to LIFE Inc’s request for testing and hereby release and hold harmless LIFE and its employees and agents from any liability arising from any request to provide information and specimens and the testing of specimens. I also specifically consent to the release of the result(s) of all pre-employment results and analysis to LIFE Inc.

File Upload

Please upload your resume and/or other necessary documents

Maximum file size: 104.86MB