On-Line Employment Questionnaire

On-Line Employment Questionnaire

    Today's Date (required)

    Contact Information

    First Name (required)

    Middle Name

    Last Name (required)

    Your Email (required)

    Home Phone (required)

    Cell or Work Telephone Number

    Home Address

    Personal Information

    Were you referred by anyone?
    YesNo

    If yes, list name and tittle:

    Have you ever been employed by Options or Christole?
    YesNo

    If yes, list title and dates:

    Do you know anyone who works at LifeDesigns?
    YesNo

    If yes, list name and title:

    How did you hear about LifeDesigns?

    Why do you want to work at LifeDesigns Inc?

    Are you at least 18 years of age? (required)
    yesno

    Do you have a valid driver’s license in the State of Indiana and a clean driving record? (required)
    Many of our positions require the ability to drive for the agency.
    YesNo

    LifeDesigns is required by regulating authorities to obtain criminal background checks on all employees

    Do you have a legal right to work in the United States? (required)
    (LifeDesigns will use to E-verify your status)
    YesNo

    Education

    Do you have the minimum of a high school diploma or GED certification? (required)
    YesNo

    Select your Highest Level of Education:

    High School

    Name:

    City/State:

    Did you graduate?
    YesNo

    Post Secondary Education 1

    Name:

    City/State:

    Major/degree:

    Did you graduate?
    YesNo

    Post Secondary Education 2

    Name:

    City/State:

    Major/degree:

    Did you graduate?
    YesNo

    Position & Availability

    What position are you interested in interviewing for?

    Anticipated rate of pay:

    Are you looking for full time of part time?
    Part TimeFull TimeEither

    When are you available to start work on?

    Many of the facilities of LifeDesigns operate 24 hours a day, 365 day a year.
    What is your availability? Please list available hours/days:

    Employment History

    Are you currently employed?
    YesNo

    If yes, please list current employer name, phone and address.

    May we contact your current employer?
    YesNo

    Past Employment History

    JOB 1

    Company Name:

    City/State:

    Job Title/Job duties:

    Dates of employment:

    Why did you leave?

    May we contact?
    YesNo

    JOB 2

    Company Name:

    City/State:

    Job Title/Job duties:

    Dates of employment:

    Why did you leave?

    May we contact?
    YesNo

    JOB 3

    Company Name:

    City/State:

    Job Title/Job duties:

    Dates of employment:

    Why did you leave?

    May we contact?
    YesNo

    Additional Information

    Any additional comments:

    You will be required to complete a paper application prior to interviewing with LifeDesigns.

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