Career - Jace Healthcare

Application Form

At Jace Healthcare, we believe our team is the heart of the care we provide. We’re looking for compassionate, reliable, and dedicated individuals who are ready to make a difference every day. Whether you’re an experienced professional or just beginning your healthcare career, we welcome you to grow with us.

Complete the application below to take the first step toward joining our caring team.

Name *

First

Last

Security Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone

Are you a citizen of the United States? *

If no, do you have a valid work permit? *

If you are under 18, can you furnish a work permit? *

Employement Desired *

Full Time
Part Time
Temporary
Seasoner

Position You Are Applying For *

CNA, CARE AIDE , SITTER , LPN or RN

Date You Can Start *

Expected Salary *

Are You Employed Now? *

If so, can we contact your present employer? *

Have you ever applied to this company before? *

Are you on layoff and subject to recall? *

your the

Will you travel if required? *

Will you relocate if job requires it? *

Will you work overtime if required? *

Are you ready to meet the attendance requirement of this position *

Have you ever been Bonded? *

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

Such conviction may be relevant if job related, but does not bar you from employment. If yes - explain *

Driver's License *

State *

Enter state where your driver's license if approved

Are you currently studying? *

High School *

Enter name of your high school

Address of your high school *

Address Line 1

Address Line 2

City

State

Zip Code

Attended From - To? *

Did you graduate? *

Degree received *

College *

College Address *

Address Line 1

Address Line 2

City

State

Zip Code

Attended From - To? *

Did you graduate? *

Degree received *

Any other certificates received *

List other certificates you have received with time period of study

Job Experience / Previous employer *

Enter job experience with responsibilities, contact details of the company and salary received per hour

References *

Enter at least 2 references, listing full name, address, phone, email, work information and position

Emergency contact *

Enter your full emergency contact details

Reporting to work with impaired abilities; or the possession, consumption or distribution of drugs or alcohol on company premises and/or worksites, shall be grounds for disciplinary action, including discharge. A condition of employment includes willingness on the part of the applicant or employee to agree to physical examination, polygraph and/or substance testing, if required by the company. We are committed to operating a drug free workplace. Violations of our drug and alcohol policy will result in dismissal. *

Agree

It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign anytime, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary *

Agree

I give the employer the right to investigate all police, driving, and personal records and references, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organization for furnishing such information. *

Agree

The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, State or Federal law *

Agree

Any controversy of any kind arising between the parties under this agreement or otherwise (or any agent, officer, director or affiliate of any party), including but not limited to common law, statutory,tort or contract claims, will be submitted to mediation and failing settlement in mediation, to binding arbitration. Unless otherwise agreed a mediation and arbitration designated by staff professionals will govern any mediation and arbitration. The parties will select the mediator or arbitrator from the designated company panel of mediators and will notify the designated company, in writing, to initiate the selection process. The arbitration will be subject to and governed by the provisions of the Federal Arbitration Act. 9 U.S.C. Section 1-et seq. The parties hereto stipulate that this agreement involves matters affecting interstate commerce. *

Agree

This application is current for 60 days. At the conclusion of this time if I have not heard from the Employer and still with to be considered for employment, it will be necessary to fill out a new application. *

Agree

Resume Upload *

Drag & Drop Files, Choose Files to Upload

Confirm your application is complete and correct *

Address

1883 Wilson Manor Circle Lawrenceville, Ga 30045

Call Us

+1 678 887 9795

Email Us

info@jacehcs.com Jacehealthcare1962@gmail.com