TLC Wheelchair Career Opportunities

Submit Your Application

Please complete the following application to be considered for a position with our team.

Applicant Information

First Name:

Last Name:

Email:

Phone:

Address:

City:

State:

Zip:

Date of Birth:

Social Security #:

Drivers License:

Date Available:

Position Applied For:

Desired Salary:

Hours Desired:

Prefer Split Shift?

Prefer Early A.M.?

Prefer Late P.M.?

US Citizen:

Are you authorized to work in the U.S.?

Have you worked for us before?

When?

Convicted of a Felony?

If yes, explain:

CPR Certified:

Cert. Expiration:

Child Safety Seat Training:

Cert. Expiration:

Defensive Driving Training:

Cert. Expiration:

First Aid Certified:

Cert. Expiration:

Passenger Asst. Training:

Cert. Expiration:

Education

High School:

Address:

Attended From:

Attended To:

Graduated?

College:

Address:

Attended From:

Attended To:

Graduated?

Other:

Address:

Attended From:

Attended To:

Graduated?

References

Please list three references other than relatives or previous employers.

Full Name:

Relationship:

Phone:

Company:

Address:

Full Name:

Relationship:

Phone:

Company:

Address:

Full Name:

Relationship:

Phone:

Company:

Address:

Job Skills (Office Positions Only)

Indicate in years and months for each area.

Accounting

Computer

Payroll

Bookkeeping

Adding Machine

Military Service

Branch

Rank at Discharge

From:

To:

Type of Discharge

If other than honorable, explain:

Previous Employment, Most Recent to Oldest

Job #1

Company:

Phone:

From:

To:

Address:

Supervisor:

May we contact?

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

Reason for Leaving:

Job #2

Company:

Phone:

From:

To:

Address:

Supervisor:

May we contact?

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

Reason for Leaving:

Job #3

Company:

Phone:

From:

To:

Address:

Supervisor:

May we contact?

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

Reason for Leaving:

Job #4

Company:

Phone:

From:

To:

Address:

Supervisor:

May we contact?

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

Reason for Leaving:

Job #5

Company:

Phone:

From:

To:

Address:

Supervisor:

May we contact?

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

Reason for Leaving:

Disclaimer and Acceptance

By submitting ths application, I certify that my answers are true and complete to the best of my knowledge.
If the submission of this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Required Fields

TLC Wheelchair Services

TLC Wheelchair Career Opportunities

Submit Your Application

Job #1

Job #2

Job #3

Job #4

Job #5