Employment Application

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Exceptional people. Exceptional care. Exceptional Careers.

Working for MFA at a LifeWorks Center is no ordinary career. It takes pride and dedication. It takes a critical combination of technical skills balanced with people skills. Most of all it takes a unique person, with a caring heart and a passion for helping others. It's more than just a job...it's a calling.

When you are part of the MFA family, you have the opportunity to touch people's lives each and every day by being an integral part of their recovery. Along the way you'll have almost unlimited opportunity for career growth and achievement. It's an incredibly rewarding and enriching experience. It's also a deeply important responsibility, and we hold our employees to exceptionally high standards.

If you have a passion for healthcare and a commitment to providing the highest level of service and excellence, click "I agree" to apply for this position.


MFA is an organization that promotes diversity. We believe in dignity and respect for all people. We provide equal employment opportunities for all and will not discriminate on the basis of sex, race, color, age, religion, national origin, marital status, disability or veteran status or any other characteristic protected by applicable law.


Emergency Contact
In case of emergency, please notify:
Employed Family Member
It is company policy that members of the same family (mother, father, sister, brother, husband, wife, son, daughter), may not work within the same chain of command or where there is a potential for conflict of interest. To avoid improper job assignments, please state which of your family members, if any, work at this healthcare center.

Employment Desired

What date would you be available to work?
E.g., 08/22/2017


Have you previously applied for employment with any MFA Healthcare Center? *
Have you ever worked for any MFA Healthcare Center? *
You may be entitled to additional paid time off (PTO) and greater 401(k) contributions if you worked for Medical Facilities of America or Medical Facilities of North Carolina in the last five years.
List below all present and past employment, beginning with your most recent.

Past Employment I

E.g., 08/22/2017
E.g., 08/22/2017

Past Employment II

E.g., 08/22/2017
E.g., 08/22/2017

Past Employment III

E.g., 08/22/2017
E.g., 08/22/2017

Past Employment IV

E.g., 08/22/2017
E.g., 08/22/2017
If not, indicate by number which employer(s) you do not wish us to contact.
Please list any professional licenses held:
License 1
Expiration Date
E.g., 08/22/2017
License 2
Expiration Date 2
E.g., 08/22/2017
License 3
Expiration Date 3
E.g., 08/22/2017
Applicants for Licensed Positions
Applicants for Licensed/certified clinical positions only (RN, LPN, Physical Therapist, Occupational Therapist, etc.)
Anticipated graduation date, if applicable
E.g., 08/22/2017
Have you ever been convicted of a crime involving theft, violence, drugs, or any law involving moral turpitude (lying, cheating, stealing)?*

A conviction will not automatically bar you from employment unless state or federal law prohibits employment of persons convicted of certain crimes. The nature of the crime, date of conviction, and the relationship of the crime to the job sought will be considered in determining eligibility for employment.

Were you ever disciplined, suspended or terminated for resident care problems?
As a professional, have you ever been disciplined by a professional group, organization, licensure board, etc.?*

Discipline by a professional group will not automatically bar you from employment unless otherwise provided by law. The nature of discipline, date of discipline, and the relationship of the discipline to the job sought will be considered in determining eligibility for employment.

Have you ever been excluded from participation in a federal health care program such as Medicare or Medicaid by way of payment or employment?

Record of Education

High School



Professional/Personal References

List three people, at least two of whom are not related to you.

Reference 1

Reference 2

Reference 3

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