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EMPLOYMENT APPLICATION

Please fill out the entire application.

Employer Name: Alongside Care LLC
Address: 2601 Rising Star Drive
City, State, and Zip Code: Diamond Bar, CA, 91765
Telephone: (714) 685-1565
Alongside Care LLC is an Equal Opportunity Employer. We do not discriminate in our hiring
practices on the basis of race, religion, color, sex, gender, identity, sexual orientation, age,
disability, national origin, religion, veteran status, or any other status protected under federal,
state, or local law.
All employment decisions at Alongside Care LLC are decided on the basis of candidate
qualifications, merit, and the unique needs of our business and the position.

I certify that all statements given on this application are true and complete to the best of my
knowledge. I understand that any statements found to be false or misleading give sufficient
reason not to hire me, or if hired, can be grounds for immediate termination. I authorize Alongside
Care LLC to conduct any investigation deemed appropriate concerning my application.
I authorize former employers, references, and all other individuals and organizations disclosed
herein to provide any information sought in connection with this application.
The employment is at will, meaning that the employment is subject to termination at any time,
with or without cause or notice, and at any time. I acknowledge that no written or oral
representations nor representations about the employment can alter the at will employment
status, except those which are executed by representatives at Alongside Care LLC with the
express authority to do so.

APPLICANT INFORMATION

Name
Email
Address (Street, City, State, Zip)
Phone Number
Alternate Phone Number
Date Of Application
Emergency Contact
Relationship To You
Address (Street, City, State, Zip)
Phone
Alternate Phone
Employment position applied for
Part Time Or Full Time


When can you begin work if you are hired?
Have you applied to any position at our company previously?


If yes, when did you apply:
If yes, what position did you apply for:
Did anyone refer you to our company? If yes, who:
Do you have any friends or family working at our company?


If yes, name:
How did you hear about this position?
Are you at least 18 years old?


If offered employment, are you able to provide proof that you are legally eligible to work in the
United States?


How you will get to work:
Driver’s License (State/Number):
Are you willing to work any shift, including nights and weekends?


If no, please state any limitations:
If applicable, are you available to work overtime?


School Name, Address, Dates Attended, and Subjects Studied:
Did You Graduate:


College/University, Address, Dates Attended, and Degree Received:
Did You Graduate:


Other Education, Address, Dates Attended, and Degree Received:
Did You Graduate:


Name of Employer, Address, Employment Dates, Key Duties, Reason For Leaving, Supervisor Name, Phone Number
Name of Employer, Address, Employment Dates, Key Duties, Reason For Leaving, Supervisor Name, Phone Number
Name of Employer, Address, Employment Dates, Key Duties, Reason For Leaving, Supervisor Name, Phone Number
Military Service


Branch:
Years Of Service (To and From):
Specialized skills or training:
Languages Spoken (Please Rate Your Fluency As Low, Medium, or High)
Other Skills (Please Rate As Low, Medium, or High)
Reference Name, Relationship, Address (Street, City, State, Zip), Phone:
Reference Name, Relationship, Address (Street, City, State, Zip), Phone:

Applicant Signature and Date
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