* Required Information

Personal Information

Full Legal Name of Applicant

In case of an emergency, we must have an emergency contact person on record.


Do you have the following:

Identified Areas of Interest

Preference will be given to Veterans

(If under age 18, hire is subject to verification of minimum legal age in the State of Minnesota)

Please Note

Employment History

Volunter Work

Professional References

Conditions of Employment

Reporting to work with impaired abilities; or the possession, consumption or distribution of drugs or alcohol on company premises and/or worksites, shall be grounds for disciplinary action, including discharge. A condition of employment includes willingness on the part of the applicant or employee to agree to physical examination, polygraph and/or substance testing, if required by the company. We are committed to operating a drug free workplace. Violations of our drug and alcohol policy will result in dismissal.

It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service, if I have been employed. Furthermore, I understand that just as I am free to resign anytime, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

I give the employer the right to investigate all police, driving, and personal records and references, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law.

Any controversy of any kind arising between the parties under this agreement or otherwise (or any agent, officer, director or affiliate of any party), including but not limited to common law, statutory, tort or contract claims, will be submitted to mediation, and failing settlement in mediation, to binding arbitration. Unless otherwise agreed, a mediation and arbitration designated by staff professionals will govern any mediation and arbitration. The parties will select the mediator or arbitrator from the designated company. Panel of mediators and will notify the designated company, in writing, to initiate the selection process. The arbitration will be subject to and governed by the provisions of the Federal Arbitration Act. 9 U.S.C. Section 1-et seq. The parties hereto stipulate that this agreement involves matters affecting interstate commerce.

This application is current for 60 days. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary to fill out a new application.

Code of Ethics for Employees

As an employee, I realize that I am subject to a code of ethics similar to which binds the professional in the filed in which I work. I, like them, assume certain responsibilities and expect to account for what I do in terms of what is expected of me.

I understand that any information that is disclosed to me while assisting WeCare, LLC is strictly confidential, and in accordance to the Data Privacy Act of 1974, including the employment application process.

If and when I’m accepted as an employee, I expect to do my work according to the standards set forth in the Personnel Policies and Procedures Employee Handbook of WeCare, LLC.


I hereby certify that the statements made on this application are true, correct and to the best of my knowledge. I understand that, by submitting this application I authorize inquiries to be made concerning my employment, character and public records for the purpose of determining my suitability as an employee. I understand that I will undergo a criminal background check paid for and by WeCare, LLC. I understand if I have patient/client contact, I will receive an annual Mantoux test later. I affirm that I have read the employee Code of Ethics and agree to abide by its regulations. I agree to respect the confidentiality of any client information I acquire in the course of my employment activities with WeCare, LLC.

WeCare, LLC does not discriminate in employment opportunities or practices. All employment related decisions are made without regard to race, color, religion, sex, pregnancy, age, national origin, public assistance, sexual orientation, ancestry, physical or mental handicap, marital status, unfavorable discharge from military service, membership or activity in a local commission, or any other illegal basis under applicable equal opportunity laws.

I declare that all the information provided is true and complete. My signature on this document provides permission to contact my references for more information and conduct a criminal background check if necessary.

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