Online Application

LifeQuest is an Equal Opportunity Employer and fully subscribes to the principles of Equal Opportunity. Applicants will not be discriminated for or against on the basis of race, color, ethnic or national origin, ancestry, religion, gender, political affiliation, veteran status, physical or mental disability, marital status, or age. To protect the interests of the people we serve, all job offers are conditional pending acceptable results of a criminal background check, a substance abuse screening, a tuberculin test, and a motor vehicle record check. All applicants must be 18 years old, have a valid drivers license, and have a High School Diploma or GED.
Name: *
Address - Street, City, State, Zip Code: *
Email Address:
Home Phone Number: *
Cell Phone Number:
Position Desired: *
Date Available To Start Work: *
Hours Wanted: *

Shifts Available check all that apply: *

Days Available check all that apply: *

Have you applied to LifeQuest Before: *
If yes, when did you apply:
Have you been employed by LifeQuest previously: *
If yes, when:
If you currently have a relative employed by LifeQuest please give their name and relationship :
How did you learn of the opening: *

If you marked Other please specify :
If you were referred by a LifeQuest employee please give their full name:
Do you require special accommodations for an interview: *
If yes, please explain:
Do you have a valid driver's liscense: *
Have you ever been convicted of a felony: *
List special skills or experiences that may be related to the position applied for:
Have you earn a High School Diploma or GED: *
Name and Location of School Attended, Degree Earned, Course of Study: *
Name and Location of School Attended, Degree Earned, Course of Study:
May we contact you present or most recent employer: *
Please provide the following information for three work experiences: Name of Employer, Dates of Employment, Job Title, Supervisor, Employer Address, Phone, Description of Duties, Reason for Leaving
Work Experience #1: *
Work Experience #2: *
Work Experience #3: *
List three references. One of your references may be a personal reference but not related to you. Include name, occupation, phone number, and type of reference (personal or business).
Reference #1: *
Reference #2: *
Reference #3: *
I certify that the information contained in this application is correct to the best of my knowledge and that any misstatement or omission of information is cause for cancellation of the application and/or separation from employment.
Signature: *
Date: *
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