Application for employment ⋆ Phoenix LLC

Welcome
About Phoenix
Services
Patients & Families

Welcome
About Phoenix
Services
Patients & Families

An Equal Opportunity Employer

Phoenix, LLC, is an equal opportunity employer.

This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization.

Applicant Name

Email Address

Address

City

State

ZIP Code

Phone Number

Date of Birth

Social Security Number

How were you referred to Phoenix LLC?

Position applying for

Do you meet the criteria for the position you're applying for?

Yes No

Are you applying for

Full time work Part time work

What days and hours are you available for work?

Are you applying for temporary work, such as summer or holiday work?

Yes No

If applying for temporary work, when will you be available?

If hired, when can you start working?

Can you work on the weekends?

Yes No

Can you work evenings?

Yes No

Can you work overtime?

Yes No

Annual salary desirted

Have you ever applied or worked for Phoenix LLC before?

Yes No

If yes, explain (include dates)

Do you have any friends, relatives or aquaintances that work for Phoenix LLC?

Yes No

If yes, state their name and relationship

If hired, do you have reliable transportation to and from work?

Yes No

Are you over the age of 18? (If under 18, hire is subject to verification of minimum legal age)

Yes No

If hired, would you be able to present evidence of your U.S. Citizenship or proof of your legal right to work in the United States?

Yes No

If hired, are you willing to submit to and pass a controlled substance test?

Yes No

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accomodation?

Yes No

If no, describe the function(s) that cannot be performed

Note: Company complies with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.

Have you ever been convicted of a criminal offense (felony or misdemeanor) including traffic violations?

Yes No

If yes, please describe the crime, state the nature of the crime(s) and when and where convicted and disposition of the case.

No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

High school name

High school address

Did you graduate high schol?

Yes No

Number of years of high school completed

Degree or diploma earned

Contact us

Phone: 540 685 4298

info@phoenixllc.org

Monday – Friday 8:30 – 5:00

Closed Saturday & Sunday

Roanoke Office

4919 Brambleton Avenue

Roanoke, Virginia 24018

P: 540 685 4298

F: 540 685 4299

Rocky Mount Office

235 Claiborne Avenue

Suite #200

Rocky Mount, Virginia 24151

P: 540 238 2080

F: 540 238 2081

SunMonTueWedThuFriSat

27282930123456789101112131415161718192021222324252627282930311234567

SunMonTueWedThuFriSat

27282930123456789101112131415161718192021222324252627282930311234567