Employment Application

Contact Long Island Assisted Living Facility

Apply for a fulfilling career at McPeak's Assisted Living by submitting the form below.

Personal Details

Name 

Home Phone: () -

Mobile Phone: () -

Email 

Address: 

City: 

State:  Zip:

Salary Requirement: 

Desired Employment: (check all that apply) 
Full-time Part-time Per Diem

Certification: (If applicable) 
LPN/RN HHA\PCA CNA Other

Résumé:


Employment History

Last Employer Company Name: 

Last Employer Address: 

Last Employer Phone: 

Last Position Held: 

Last Employment Date (Start): 

Last Employment Date (End): 

May we contact your previous employer? 

 

How did you hear about us? 

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