Employee Application

Application Requirements

18 years old or above

NC State Driver's License

High School Diploma or GED

US Citizen

Prefix

First Name *

Middle Name

Last Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Email Address *

Date of Birth *

Social Security Number *

Driver's License Number *

State *

Expiration Date *

Have you been convicted of a felon in the last 7 years? *YesNo

If yes, please explain

Are you a citizen of the United States? *YesNo

What position are you applying for? *Administrative AssistantHabilitation TechnicianGroup Home ManagerHuman Resource Manager

Date you can begin working *

Please choose from the following options: *I have filed an application with Mercy Care Inc. beforeI have been employed with Mercy Care Inc. beforeI have never filed an application or been employed with Mercy Care Inc.

Are you currently employed? *YesNo

If yes, may we contact your employer? Include your employer's contact information

Employment Experience *

High School Education *

Undergraduate Education

Graduate/Professional Education

Check any specialized skills or expeirences that applyComputer SkillsCNA I or IISchoolNursing/Rest HomeHospitalGroup Home/Home HealthCPR/First Aid

If you are CPR/First Aid certified, please give the expiration date

Please list at least 2 references *

State any additional information you feel may be helpful in considering your application

By clicking Agree, I give my consent to Mercy Care Incorporation 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 *AgreeDisagree

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Office HOURS

Monday – Friday: 9am – 5pm

LOCATION

You can find us at 415 Warsaw Rd. Suite B Clinton, NC

Have questions? You can give us a call at (910) 590-5151 or email us at mercycareinc@yahoo.com

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