Application for Hiring

Fill out the form below and someone will be in touch with your shortly! All fields are required

Personal Information

Your Name (Required)

Your Address (Required)

Your Phone (Required)

Your E-mail (Required)

Are you a U.S. Citizen? (Required) Yes No

Have you ever been convicted of a felony? (Required) Yes No

If selected for employment, are you willing to submit to a pre-employment
drug screening test? (Required) Yes No

Position

Position you are Applying For (Required)

Available Start Date (Required)

Desired Pay (Leave blank if unsure)

Employment Desired: (Required) Full Time Part Time Seasonal/Temporary

Education (Required)

School Name:

Location: Years Attended: Degree Received: Major:

School Name:

Location: Years Attended: Degree Received: Major:

School Name:

Location: Years Attended: Degree Received: Major:

School Name:

Location: Years Attended: Degree Received: Major:

References (Required)

Reference Name:

Job Title: Company: Phone:

Reference Name:

Job Title: Company: Phone:

Reference Name:

Job Title: Company: Phone:

Employment History (Required)

Employer 1:

Job Title: Work Phone: Address: Month/Year Started: Month/Year Ended: Starting Rate: Ending Rate:

Employer 2:

Job Title: Work Phone: Address: Month/Year Started: Month/Year Ended: Starting Rate: Ending Rate:

Employer 3:

Job Title: Work Phone: Address: Month/Year Started: Month/Year Ended: Starting Rate: Ending Rate:

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. By typing my name in the box below, I also understand that my electronic signature carries the same weight as a handwritten signature.

Name: Date:

Contact Information

2770 Hwy 501 S
Marion, SC 29571
Phone: (855) 573-8466
Fax: (855) 573-8466
Email: hiring@scomsc.com
Facebook: Senior Care of Marion

Application for Hiring

Personal Information

Position

Education (Required)

School Name:

School Name:

School Name:

School Name:

References (Required)

Reference Name:

Reference Name:

Reference Name:

Employment History (Required)

Employer 1:

Employer 2:

Employer 3:

Contact Information

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