Emplyoment Application

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About
Meet Us
Patient Center
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Contact
Direction
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中文

Employment Application

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Reason for Applying *

Please put your cover letter here, briefly introduce yourself and why you think this job may be a good fit for you

Upload Resume (Skip if already emailed) *

Max file size: 20MB

Upload your resume/cover letter

Certification/Qualification *

Certified Medical Assistant (CMA) Certified Chiropractic Assistant (CA) Certified Nursing Assistant (CNA) Other (Please specify)

Please list any certification you have

Other: *

Are you employed now? *

Did you apply through *

Salary Desired: *

$17.50 per hr $18.00 per hr $19.00 per hr Other (Please write in below)

Other: *

Please write in your desired salary.

Work Availability *

Monday morning Monday afternoon Wednesday morning Wednesday afternoon Saturday

Date Available to Start *

Have you ever been convicted of a crime? *

If yes, explain numnbers of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentences(s) imposed, and type(s) of rehabilitation. *

Are you a U.S. Citizen or otherwise authorized to work in the United States on an unrestricted basis? *

Comment/Special Skills/Language Skills *

Are you willing to take a COVID-19 test if hired prior to your first day of work *

Professional Reference: *

Name *

First

Last

Relationship *

Current Employer Previous Employer Other

Other (Please specify): *

Phone Number *

Email *

May we contact this reference/employer? *

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statement contained herein and there references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you.

Choose One *

I certify I do not certify

Signature (Type in Full Name): *

Submit

Location

Office Hours

Monday 10:00 AM - 7 PM
Wednesday 10:00 AM - 7 PM
Saturday 9 AM -3 PM

Office Information

Dr. Jack Li, D.C.
12340 Santa Monica Blvd, Suite 129
West Los Angeles, CA 90025

Call us at for an appointment
(310) 207-1007
Text: (323) 452-3606

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Home
About
Meet Us
Patient Center
DOT Physical
Contact
Direction
- Parking
中文