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Personal Info

Address
Contact
If not a U.S. citizen, do you have the legal right to remain permanently and work in the U.S.?

Employment

Will you accept employment for Full Time?
Are you 18 years of age or older?
Have you worked for us before?
Have you ever received Unemployment Insurance?
Have you ever received Worker’s Compensation?
Have you ever received Disability Insurance?
Are you employed now?
May we contact your present employer?

Education

Name of School
Location
Course Taken
Date Completed
Diploma, Degree or Certificate Received
Grammar or Grade School
High School
College
Vocational or Business
Professional Education
Laboratory or X-ray Trng.

Honors Received, Volunteer or Community Service or Other Qualifications You Have which you feel are related to the position for which you are applying:

Military Service

Have you ever served in the U.S. Armed Forces?

What is your present selective service classification?

Are you presently a member of the reserve or national guard?

If so, when is your enlistment up?

Professional License and/or Certification

Type
Organization or State Issued
Date Issued
Number
Verification

Employment Record

Please list most recent employer first including summer or temporary jobs.
Present & Former Employers
Dates Employed
Position & Duties
Reason for Leaving
Please explain all periods of unemployment:
Other names by which you have been known (for date verification and reference checking purposes).
Have you ever been convicted of a crime?
If so, for what, when and where?

References

Please list two references other than relatives or previous employers.
Name and Occupation
How do you know them and for how long?
Phone Number
Do you consider yourself to be able to perform all the duties required by the job(s) for which you are making an application without endangering yourself, other employees or patients?
If “No” please explain:

By submitting this application, you certify that answers given herein are true and complete to the best of my knowledge. You authorize investigation of all statements contained in this application for employment as may be necessary for arriving at an employment decision.

You hereby acknowledge that any employment relationship with this company is of an “at-will” nature, which means that the Employee may resign at any time and the Employer, may discharge Employee at any time with or without cause. It is further understood this “at- will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of the Company.

In the event of employment, you understand that false or misleading information given in this application or interview(s) may result in discharge. You understand, also, that you are required to abide by all rules and regulations of the employer.

Why Work With Us

At Asian Heritage Healthcare, we celebrate diversity and inclusion to strengthen our team and enhance client care, creating a vibrant environment where all voices are respected and enabling us to better serve the diverse needs of our communities while making a meaningful impact in seniors’ lives.

Professional Development

We are committed to our team’s growth, offering training programs and educational opportunities in traditional and modern healthcare practices. With workshops, certifications, and access to the latest research, we help you enhance your skills and explore new technologies in senior care, all while making a meaningful impact in seniors’ lives.

Culturally Sensitive Healthcare

At Asian Heritage Healthcare, we serve underrepresented communities through culturally sensitive care, empowering our team to address diverse needs with personalized support, build trust, and make a tangible difference in the lives of seniors while fostering a healthier, more inclusive community.

Get in Touch

1818 S. Western Ave. Suite 100
Los Angeles, CA 90006-5862

Office: 888-804-1118
Email: [email protected]

Opening Hours

  • Mon - Fri
    9 am - 6 pm
  • Sat - Sun
    Closed
For after hours please call

Customer Service

Give us a call at: 888-804-1118
Or click below
Call Now

Asian Heritage Healthcare aims to provide fully integrated health and social care for older adults on Medicare or Medicaid who want to live independently in their homes and communities. Our model operates through the Program of All-Inclusive Care for the Elderly (PACE) in partnership with local community organizations.