Application for Employment

McClure Comfort Care is currently accepting creative and hard working applicants to fill a number of available positions.
To ensure proper consideration, please fill in the information below as completely and accurately as possible.

Personal Information

* First Name

* Last Name

* Address 1

Address 2

* City

* State

* Zip Code

* Phone

Cell Phone

* Email Address

* Position Applying For

* Are you legally authorized to work in the United States?

Yes

* Have you ever been convicted of a felony?

Yes

If yes, please explain.

Certifications

* Employment Desired

Full Time

Part Time

Contract

Availability

Days and Times Available

	AM From	AM To	PM From	PM To
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Employment History

Employer (most recent)

May we contact this Employer

Yes

If No please Explain why .

Address

City

State

Zip Code

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Ending Salary

Supervisor/Manager

Reason for Leaving

Employer

May we contact this Employer

Yes

If No please Explain why .

Address

City

State

Zip Code

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Ending Salary

Supervisor/Manager

Reason for Leaving

Employer

May we contact this Employer

Yes

If No please Explain why .

Address

City

State

Zip Code

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Ending Salary

Supervisor/Manager

Reason for Leaving

Employer

May we contact this Employer

Yes

If No please Explain why .

Address

City

State

Zip Code

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Ending Salary

Supervisor/Manager

Reason for Leaving

References

Name

Address

Phone

Email Address

Name

Address

Phone

Email Address

Name

Address

Phone

Email Address

Additional Skills

Typing Speed (words per minute)

List any additional skills that you would like to mention.

Please submit a copy of your resume.(please click upload before hitting the submit button )

* Indicates Response Required