Application
INCOR is an Equal Employment Opportunity Employer (EEOC). We do not discriminate against qualified applicants based upon any protected group status, including but not limited to race, color, creed, religion, gender, national origin, ancestry, age, marital status, military or veteran status, sexual orientation, physical or mental disability or medical condition or any other characteristic protected by law as defined.

This application will be considered active for 90 days. If you have not been hired within 90 days of submitting this application and you wish to be considered for employment, you must complete a new application.
Sign in to Google to save your progress. Learn more
Email *
Applicant's First, Middle, Last Name *
Mailing Address *
Phone Number *
Have you been employed with INCOR before? *
What position are you applying for? *
Are you seeking part time or full time? *
Required
Are there certain shifts you are interested in? *
Required
What days are you available? *
Required
If hired, when can you start? *
MM
/
DD
/
YYYY
Do you have relatives working for INCOR? *
If yes, list name(s). Otherwise, put N/A (not applicable) *
How did you hear about us? *
If referred by an employee, list name. Otherwise, put N/A (not applicable) *
What training or certifications have you received? *
Must provide copies upon hire
In order to work for INCOR, you must have the following:
These are mandatory before hire!
Must be 18 years or older *
Do you have a valid drivers license? *
Clean, reliable transportation? *
Some positions will require you to transport individuals around the community.
Current auto insurance? *
You may be required to lift up to 40lbs, as well as bending, twisting, stooping, and walking. Can you perform these activities without assistance? *
Are you eligible for work in the US? *
High School Diploma or GED? *
We are required to check criminal records, references, and abuse and neglect registry before hiring.
If there is anything on your background, do you have a disposition for said conviction? *
A copy will be required before you can be put to work.
Would you be willing to take a drug test as a condition of employment? *
Have you ever served or currently serve in the military? *
If yes, please list rank, date of service, and any relevant skills required. Otherwise, put N/A (not applicable). *
If offered a position, would you be willing to provide identification of your sex, and ethnicity/racial group and/or disability so that we can monitor the effectiveness of our EEOC program? *
Providing the information will not affect your employment application.
Please list all previous employment, starting with the most recent. MM/DD/YYYY *
Please list 3* references with name and phone number *
Are you capable of using technology such as a tablet or computer to clock in/out and complete documentation? *
Do you have experience working with people with disabilities? *
If yes, please explain. Otherwise, put N/A (not applicable). *
Have you worked with an individual who could get physically aggressive (hits, bites, scratches, etc)? *
How did you feel about working with someone who could get physically aggressive? *
How do you feel about working with someone who does not communicate in words? *
On a scale of 1 to 5, one being very comfortable and five being unwilling or unable to do it, rank yourself on the following tasks.
Cook healthy meals *
House cleaning *
Bathing clients *
Toileting *
Changing briefs *
Providing other total care activities (may include tube feeding, colostomy care, etc.) *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms