Group Home Employee Application

Mercy Care Inc.

Name *

First

Middle

Last

Address *

First

Middle

Last

Date of Birth *

Phone Number *

What position are you applying for?

Desired Shift

Have you ever been convicted of a felon in the past 7 years? *

If yes, please explain

Are you a citizen of the United States? *

Have you lived in North Carolina for the past 5 years? If not, please list all locations lived withing the past 5 years

Date you could begin working?

By clicking Agree, I give my consent to Mercy Care Inc. to perform a criminal records check required for the position for which I have applied. I understand that by clicking Disagree to this records check will exclude me from consideration for the job position *

Agree
Disagree

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