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WORK WITH US.

Full time positions available

CMA

PRN CMA

CNA

PRN CNA

Fill out the application below to work with us.

Applicant Information

First Name

Middle Name

Last Name

Address

Phone

Email

Position applied for

Date available to start

Social Security Number

Desired salary

Are you a citizen of the United States?

Yes

No

Have you ever worked for Lois House?

Yes

No

Have you ever been convicted of a felony?

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

If yes, when?

If yes, explain:

Education

High school:

Address:

From?

To?

Did you graduate?

Yes

No

Diploma:

College:

Address:

From?

To?

Did you graduate?

Yes

No

Diploma:

Other:

Address:

From?

To?

Did you graduate?

Yes

No

Diploma:

References

Please list three professional references.

Full name:

Relationship:

Company:

Phone:

Address:

Full name:

Relationship:

Company:

Phone:

Address:

Full name:

Relationship:

Company:

Phone:

Address:

Previous employment

Company:

Phone:

Address:

Job title:

Starting salary $:

Supervisor:

Ending salary $:

Responsabilities:

From:

To:

Reason for leaving:

May we contact your previous supervisor for a reference?

Yes

No

Company:

Phone:

Address:

Job title:

Starting salary $:

Supervisor:

Ending salary $:

Responsabilities:

From:

To:

Reason for leaving:

May we contact your previous supervisor for a reference?

Yes

No

Military service

Branch:

From:

To:

Rank at discharge:

Type of discharge:

If other than honorable, explain:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Your Signature

Thanks for applying to work with us! We'll get back to you soon.

ADDRESS

2734 N Wellesley St, Wichita, Ks 67220

Telephone: 316-217-8543

Tracy Allen: 316-461-2235

Toji Jones: 316-204-8701

OPENING HOURS

Monday - Friday

9 am - 5 pm

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