Life Force Services, Inc
Online Application



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Note: Life Force Services will consider applications equally whether they are submitted online on in person. However if you feel uncomfortable with an online application, you may visit either of the locations below to pick up a paper application.
Olympia/Lacey
4305 Lacey Blvd SE Suite 29
Lacey, WA 98503
Phone #: 360-923-0333		  Tacoma
1212 S. 11th St Suite 45
Tacoma, WA 98405
Phone #: 253-671-1818  

Directions: Fill out the form below with accurate and honest information. Leave a field blank only if honesty requires you to do so.  (Example: If you worked at the same place for the last 8 years, you could leave the other two 'previous job' sections blank)  However, do not omit any honest information. When you are finished filling out all the fields, click the "submit my application to Life Force' button at the bottom.

Personal Information
First Name      Last Name Middle Intial:

 Birthdate Social Security Number
Day: Year: - -
Address
 City
 Zip Code

Phone Number Email
( ) -

Emergency Contact Person
 Phone Number
 Relation

( ) -


Job-Related Information
Education Completed
 Where?
 When?


Have you recieved a GED or High School Diploma?
 Date recieved
Yes: No:

   Day: Year:
Position Applying For?
 Proposed Hourly Wage:
$   per hour
Do you have reliable transportation?
 Are you legally employable in the United States?
Yes: No: Yes: No:



Shift Availability
What Shift(s) are you willing to work?
 Days Swings Nights
What Shift(s) do you prefer?
 Days Swings Nights
Are you willing to work weekends?
 Yes No

Note:  This job may include transfers and lifting of  residents, bending and kneeling while cleaning.

Background Information
Have you ever been convicted of a felony?*  (if yes, explain in 'additional information' box below)
 Yes No
Do you have a history of alcohol/substance abuse or addiction?
 Yes No
Have you ever experimented or used any illegal drugs/substances?
 Yes No

* Washington State Law prohibits Life Force Services from hiring or retaining employees who have been convicted of certain specified offenses. However, a conviction record will not necessarily be a bar to your employment except to the extent required by Washington State Laws. DSHS will consider your age at the time of the offense, the seriousness of the offense, the nature of the offense, your rehabilitation, and whether you are bondable, in determining whether you will be eligible for employment.


Work Experience

(Last 8 years, list most recent first)

Last Job
Employer
 Address
Supervisor
 Phone
( ) -
From
 To:
Day: Year: Day: Year:
Position
 Hourly Wage
$   per hour
Reasons for Leaving

Previous Job 1
Employer
 Address
Supervisor
 Phone
( ) -
From
 To:
Day: Year:   Day: Year:
Position
 Hourly Wage
$   per hour
Reasons for Leaving

Previous Job 2
Employer
 Address
Supervisor
 Phone
( ) -
From
 To:
   Day: Year:    Day: Year:
Position
 Hourly Wage
$   per hour
Reasons for Leaving

References

List 3 Personal references other than relatives (include address and phone number):
Name
 Address
 Phone
( ) -
Name Address Phone
( ) -
Name Address Phone
( ) -

Additional Information
Military Service?  Yes: No:   Date of Discharge:    Day: Year:

Other volunteer and community experience working with special populations?


Any Additional information that you would like included with your application goes here.

CONSENT TO VERIFICATION OF REPRESENTATIONS

I understand that the company may wish to verify representations contained in this application. I also understand that as directed by company policy and consistent with the job described, you may be requesting information from public and private sources about my: driving record, court records, education, credentials, credit and references. I hereby give my consent to the company and its agents to fully investigate the representations contained in this application as well as to investigate my personal history. I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contacted by Life Force Services, or its agents to furnish information as to my character, work habits, performance, and experience, along with reasons for termination of past employment. I release Life Force Services, its agents, and any person who provides information to Life Force Services, or its agents, from any claims that I may have for supplying information to Life Force Services, Inc. or its agents. Representations: I represent and warrant that the information set forth in this application is complete, true, and correct in all respects. I understand that a material misstatement or omission of fact is grounds for the termination of my employment. "At-will" Employment: I understand that employment with Life Force Services, Inc. is "at-will". Life Force Services and its employees each retain the right to terminate the employment relationship at any time, with or without just cause. Nothing contained in the company's employment manuals or policy statements are intended to modify this principle. This policy may be altered or amended only by and with the written consent of the President of Life Force Services.



 I have read and understand the above.



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All contents copyright Life Force Inc 2004. Designed by Luke Bradley.