Apply Online
Use this online application to apply for a position with LifeCare. Required fields are noted (*). Once you have completed the application, please click Submit Application.
   Personal Information
*Date of Application (MM/DD/YY):   
*First Name: *Middle Initial:   *Last Name:
*Address:
*City: *State:                 Zip:
E-Mail Address:  
*Phone:   - - Alternate Telephone:   - -
*How did you hear about LifeCare? 
If you listed other, please specify:   
*Position applied for:  
If you listed other, please specify:  
*Desired hours:  
If part time, what days and hours are you available?
*Have you ever applied to LifeCare in the past?               If yes, state when:
*Have you ever been employed by LifeCare?  
If yes, state when and in what capacity:
*Do you have relatives employed by LifeCare?  
If yes, state their names:
*Are you legally authorized to work in the U.S.? 
*Can you perform the essential duties of the position with or without reasonable accommodation? 
*Are you over 21 years of age?             If no, can you provide proof of eligibility to work? 
If the position requires driving authority, do you have a valid Virginia driver's license? 
*Can you travel if your job requires it? 
*Are you currently on 'lay-off' status and subject to recall? 
*Have you ever been convicted of a misdemeanor or felony? Conviction will not necessarily disqualify an applicant from employment. 
If yes, please explain:
*Have you ever been convicted of Driving under the Influence or Driving while Intoxicated? 
If yes, please explain:
*Have you ever been associated with a rescue squad or fire department? 
If yes, state the agency name, leader's name, address and phone number:
   Training & Certifications
*Do you have EMS certifications? 
If yes, state your certifications:
National Registry Virginia State Certification
Level:  Level: 
Certification Number: Certification Number:
Expiration Date (MM/DD/YYYY):  Expiration Date (MM/DD/YYYY): 
Indicate other certifications that you hold, and the expiration date:
Expiration Date (MM/DD/YYYY): 
Expiration Date (MM/DD/YYYY): 
Expiration Date (MM/DD/YYYY): 
Expiration Date (MM/DD/YYYY): 
Expiration Date (MM/DD/YYYY): 
Educational Backgroundadd another school
*School Attended:
*City: *State:
Major Studies: *Did you graduate?
Diploma/Degree:
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Employment Historyadd another employer
*Employer Name:
*Address:
*City:     *State:       Zip:     Phone: - -
*Job Title:     *Start Date(MM/DD/YY):         *End Date(MM/DD/YY):  
Starting Pay Rate: *Ending Pay Rate:  
Duties:
*Name of Supervisor:       *Permission to contact:  
*Reason for Leaving:
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Reference(s)add another reference
*Name: *Relationship:
*Address:
*City: *State:   Zip:  
*Phone:    - - Alternate Phone: - -
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Summarize special job related skills and qualifications acquired from employment or other experience.
   Applicant Statement
I certify that all of the information I have provided in this application is true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary to arrive at an employment decision. I understand that any false or misleading information may be grounds for not employing me, and in the event of employment, may result in discharge. I authorize you to contact former employers, schools, references, and others, and hereby release them from liability in regard to any disclosure of information.

I understand that I will be required to submit to, and successfully pass, an initial drug screening and subsequent drug screenings as a condition of employment. Drug screenings shall be conducted on an unannounced random basis and following any motor vehicle accident. I understand that refusal to take a drug test or failure to pass a drug test may lead to immediate termination.

I understand that I am required to abide by all rules and regulations of the company. It is further understood that my employment with the company is at-will and may be terminated at any time with or without cause by the company or myself.

By pressing the submit button, I hereby affirm that I have read, understand, and agree to the applicant statement written above.