AHS Employment Application

Amasiekarr Health Solution 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 needing reasonable accommodation in the application process should contact a company representative.

1. Applicant Information

Applicant Name *

Date of Application *

Address *

City, State and ZIP Code *

Telephone Number *

Email Address *

2. Employment Position

Position(s) applying for *

How did you hear about this position?

What days are you available for work?

What hours or shift are you available for work?

If needed, are you available to work overtime?

On what date can you start working if hired?

Do you have reliable transportation to and from work?

Salary desired

3. Personal Information

Have you ever applied to or worked for AHS before?

If yes, when?

Friends, relatives, or acquaintances working for AHS?

If yes, state name & relationship

Are you 18 years or older?

U.S. citizen or approved to work in the U.S.?

Proof of citizenship/legal status

Consent to mandatory controlled substance test?

Condition requiring job accommodations?

If yes, describe accommodations required

4. Job Skills / QualificationsPlease list the skills and qualifications you possess for the position for which you are applying.

Amasiekarr Health Solution LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.

5. Education and Training

High School

Name

Location (City, State)

Year Graduated

Degree Earned

College / University

Name

Location (City, State)

Year Graduated

Degree Earned

Vocational School / Specialized Training

Name

Location (City, State)

Year Graduated

Degree/Certificate Earned

6. Military

Are you a member of the Armed Services?

Branch of military

Rank when discharged

Years served

Military skills that would be an asset for this position

7. Previous Employment

8. References

Please provide 3 personal and professional references.

9. At-Will Employment Acknowledgment

The relationship between you and Amasiekarr Health Solution LLC is referred to as “employment at will.” This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or Amasiekarr Health Solution LLC. No representative of Amasiekarr Health Solution LLC has authority to enter into any agreement contrary to the foregoing “employment at will” relationship. You understand that your employment is “at will,” and acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

Applicant Signature *

No signature added. Signature preview

Signature Date *

10. Application Documents

Upload the documents applicable to your position. The original AHS checklist includes resume, academic/professional credentials, health form, work eligibility, CPR/First Aid, driver's license, background/clearance documents, references, direct deposit documentation, and NPI if applicable.

Accepted: PDF, DOC, DOCX, JPG, JPEG, PNG. Maximum 10 MB per file; maximum 12 files. Only upload documents requested by AHS.