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Employment Application

To apply, please fill out our application, background check, and references forms

1) Application

2) Background Check

3) References

Employment Application

"*" indicates required fields

Personal Information

Application may not be processed unless all areas are complete.

Name*

First Last

Date

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

How did you hear about this job?

Lirio Resources Website

Social Media

Indeed

Walk-in

Referral from Current Employee

Name of referring employee

Hours desired

Full time

Part time

If full time hours are not available, would you be willing to work part time?

Yes

No

Shifts desired

First Shift

Second Shift

Third Shift

Are you available to work weekends?

Yes

No

Are you available to work on holidays?

Yes

No

Are you available to work overtime if needed?

Yes

No

Are you able to work additional hours with a minimal notice?

Yes

No

Do you have any family member(s) that currently work for Lirio Resources?

Yes

No

Name(s) of Family Member(s) who currently work for Lirio Resources

Primary Emergency Contact Name

First Last

Primary Emergency Contact Phone Number

Prescreen Questionnaire

Are you legally authorized to work in the United States?

Yes

No

Will you now or in the future require sponsorship for employment visa status (e.i., F-1, H-1B, TN status)?

Yes

No

Are you a preferred caregiver? (A person taking care of a family member/personal relative)

Yes

No

Have you ever worked at Lirio Resources (formerly CDC Resources, Inc.)?

Yes

No

Have you ever been convicted of fraud or another felony in violation of state or federal law that has not been expunged by the court?

Yes

No

If yes, please explain.

Have you ever been convicted of a misdemeanor in violation of state or federal law that has not been expunged by the court?

Yes

No

If yes, please explain.

Have you ever had an action taken against your professional license or certification?

Yes

No

If yes, please explain.

Resume

Do you have a complete resume?

Your resume must include your education, work history, and contact information for three references.

Yes

No

Resume Upload

Max. file size: 10 MB.

Education

What is the highest level of education you have completed?

High School Diploma / GED

Associates Degree

Bachelors Degree

Masters Degree

Doctoral Program

Educational Institution

Major or Specialization

List any related Certifications or Professional Licenses

Employment History

Company Name

Job Title

Summary of Responsibilities

Company Address

City State / Province / Region

Employment Start Date

MM slash DD slash YYYY

Employment End Date

MM slash DD slash YYYY

Company Name

Job Title

Summary of Responsibilities

Company Address

City State / Province / Region

Employment Start Date

MM slash DD slash YYYY

Employment End Date

MM slash DD slash YYYY

Company Name

Job Title

Summary of Responsibilities

Company Address

City State / Province / Region

Employment Start Date

MM slash DD slash YYYY

Employment End Date

MM slash DD slash YYYY

Professional References

Please provide at least 3 (three) professional or school references. Do Not include family members or other relatives.

Professional Reference #1

First Last

Email

Phone

Years Known

Professional Relation

Professional Reference #2

First Last

Email

Phone

Years Known

Professional Relation

Professional Reference #3

First Last

Email

Phone

Years Known

Professional Relation

Consent and Agreement

Consent*

I hereby authorize Lirio Resources, (formerly CDC Resources, Inc.) to verify the information provided on this employment application. Information subject to verification includes but is not limited to: Professional References: character reference; Former employment: dates of employment, main responsibilities, average hours per week, supervising experience, quality of work performed, the reason for leaving, and eligibility for rehire; Education, License, and Certification: Existence on the registry, degree, GPA, expiration date(s).

I agree and consent to verification.

Initials*

Date*

Month

Day

Year

Phone

This field is for validation purposes and should be left unchanged.

To apply, please fill out our application, background check, and references forms.

1) Application

2) Background Check

3) References

Office Hours

Monday – Friday
8 a.m. – 4:30 p.m. (local time)

Address

5053 Norway Road
Monticello, Indiana 47960
(EDT)

1320 East Angelica Street
Rensselaer, Indiana 47978
(CDT)

Phone

(574) 583-8227 – Monticello
(219) 866-3282 – Rensselaer

FAX

(574) 583-6454 – Monticello
(219) 866-5152 – Rensselaer

Quick Links

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Lirio Resources equips individuals and families with support to participate fully in living, learning, working, and playing.

Employment Application

Employment Application

Personal Information

Prescreen Questionnaire

Resume

Education

Employment History

Professional References

Consent and Agreement

Office Hours

Address

Phone

FAX

Quick Links

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