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Application for Employment

Staffing Employment Application

Elevion Care Network LLC · 97 Herrington Dr, Upper Marlboro, MD 20774 · Phone: (202) 710-0131 · Email: elevioncarenetworkllc@gmail.com

Elevion Care Network LLC is an Equal Opportunity Employer. Employment offers are made based on qualifications and without regard to race, color, sex, religion, national or ethnic origin, disability, age, veteran status, sexual orientation, or any other status protected by law.

Instructions: Complete all sections clearly — please type or print. You may attach a resume, but you must still complete all questions — please fill out each box (don't just write "See Resume"). Enter N/A where a question does not apply. Applications with missing information may not be considered. Required fields are marked *.

Security notice: Applications are sent over HTTPS, saved in Elevion's private hiring portal and a copy is emailed to elevioncarenetworkllc@gmail.com. Do not enter Social Security, driver's license or work permit numbers here — HR collects them securely during onboarding. Do not upload images of ID cards, passports or medical records.

01Applicant InformationSection 1 of 10
02Position and AvailabilitySection 2 of 10
Position(s) requested
Employment preference
Preferred shifts
Can you reliably travel to assigned locations?
03Work Eligibility and General InformationSection 3 of 10
Are you eligible to work in the United States?
Work authorization status
Are you 18 years of age or older?
Are you currently employed at Elevion Care Network?
Have you ever been employed by Elevion Care Network?
Are you related to any current Elevion employee?
If required for position, do you have a valid driver's license?
How did you learn about this employment opportunity? (check all that apply)
04Education and TrainingSection 4 of 10

High School

Name of school
City / State
Did you graduate?
If no, # of years left
If yes, date of graduation
Degree received
Major

GED

Name of school
City / State
Did you graduate?
If no, # of years left
If yes, date of graduation
Degree received
Major

Other School

Name of school
City / State
Did you graduate?
If no, # of years left
If yes, date of graduation
Degree received
Major

College

Name of school
City / State
Did you graduate?
If no, # of years left
If yes, date of graduation
Degree received
Major

College (2)

Name of school
City / State
Did you graduate?
If no, # of years left
If yes, date of graduation
Degree received
Major

College (3)

Name of school
City / State
Did you graduate?
If no, # of years left
If yes, date of graduation
Degree received
Major
05Professional Licenses and CertificationsSection 5 of 10

List license numbers only — do not upload license scans here.

License / certification 1

Type (RN, LPN, CNA, GNA, CMT…)
Number
Issuing state
Expiration
Status

License / certification 2

Type (RN, LPN, CNA, GNA, CMT…)
Number
Issuing state
Expiration
Status

License / certification 3

Type (RN, LPN, CNA, GNA, CMT…)
Number
Issuing state
Expiration
Status
CPR certification (BIS)
First Aid certification (BIS)
06Skills and Care SettingsSection 6 of 10

List technical, clerical, trade or clinical skills relevant to this position, including computer systems and software, and note your level of proficiency.

Skill 1

Skill / system / software
Proficiency

Skill 2

Skill / system / software
Proficiency

Skill 3

Skill / system / software
Proficiency

Skill 4

Skill / system / software
Proficiency
Relevant skills
Additional experience
Care settings worked
07Employment History — Current or Most RecentSection 7 of 10

Please detail your entire work history, beginning with your current or most recent employer. If you held multiple positions with the same organization, detail each separately. Explain any gaps in employment and include full-time military or volunteer commitments. Please do not complete this section with "See Resume." Omission of prior employment may be considered falsification of information. Elevion Care Network LLC reserves the right to contact all current and former employers for reference information.

Employer 1 (current / most recent)

Employment type
Contact my current references
May we contact this employer?
08Employment History — Previous EmployersSection 8 of 10

Employer 2

Employment type
Contact my current references
May we contact this employer?

Employer 3

Employment type
Contact my current references
May we contact this employer?
09Professional References, Emergency Contact & ResumeSection 9 of 10

Reference 1

Name
Title / organization
Phone / email
Relationship

Reference 2

Name
Title / organization
Phone / email
Relationship

Accepted: .pdf, .doc, .docx up to 5 MB. Do not upload Social Security cards, passports, or medical records.

Up to 5 files · PDF, JPG or PNG · 5 MB each. Photos of certificates are fine. Do not upload ID cards, Social Security cards or medical records.

Up to 3 files · PDF, DOC, DOCX, JPG or PNG · 5 MB each. Do not upload passports, Social Security cards or medical records.

10Applicant Certification, Consent and SignatureSection 10 of 10

Please read carefully and sign that you understand and accept this information

  1. I certify that the information provided on this application and in all supporting documents is accurate and complete. I understand and agree that failure to fully complete this form, or any misrepresentation or omission of facts, may result in disqualification from consideration for employment or termination of employment if discovered at a later date.
  2. I authorize Elevion Care Network LLC to investigate, without liability, all statements contained in this application and supporting materials. I also authorize references and former employers to respond fully, without liability, to any inquiries regarding my application for employment.
  3. If requested, I agree to submit to a physical examination, criminal background investigation, credit background investigation, and/or screening for illegal substances upon receipt of a conditional offer of employment.
  4. I understand that this document is not an offer of employment and that any offer of employment, if extended, does not constitute a contract for continued or guaranteed employment. I further understand that employees of Elevion Care Network LLC are employed at will, and the employment relationship may be terminated at any time by either party, with or without cause or notice, except as prohibited by law.
  5. If employed, I will be required to provide proof of eligibility to work in the United States. I understand that if employed on a temporary basis, I will be compensated only for hours worked and will not be eligible for benefits, including paid time off.
  6. If employed in a regular, benefits-eligible position, I understand that I may be required to make mandatory contributions to designated organizations. I also understand that any benefits I receive may be modified or discontinued at any time without prior notice.