Home
About Us
- Learn More
- Photo Gallery
Services
Careers
- Available Positions
- Employment Application
Contact Us

Select Page

Employment Application

Come and make a difference in the lives of those we serve. Fill out an application today!

A nurse with a resident

Employment Application

Come and make a difference in the lives of those we serve. Fill out an application today!

1Personal Info

2Education

3References

4Work History

PERSONAL INFORMATION
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
Are you at least 18 years of age?
- Yes
- No
Professional License Number
License Type
If you are not a U.S. citizen, do you have the legal right to remain permanently and work in the U.S.?
- Yes
- No

EMPLOYMENT DESIRED
Position you are applying for
Shift(s) You Can Work
- Days
- Evenings
- Nights
- Any
Date you can start
Month
Day
Year
Type of Work
- Full Time
- Part Time
EDUCATION
Highest level of education you have completed?
Name of last school attended?
Degree attained?
Type of training
- Vocational
- Trade
- Other

REFERENCES
Reference #1 Name
First Last
Reference Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference Phone
Reference Email
In what capacity do you know this person?
Reference #2 Name
First Last
Reference Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference Phone
Reference Email
In what capacity do you know this person?
Reference #3 Name
First Last
Reference Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference Phone
Reference Email
In what capacity do you know this person?

WORK EXPERIENCE
List below your work experience, starting with your present or last place of employment.
EMPLOYMENT #1
Start Date of Employment
Month
Day
Year
End Date of Employment
Month
Day
Year
Name of Company
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Phone
Supervisor's Name
Position Held
Reason for Leaving
EMPLOYMENT #2
Start Date of Employment
Month
Day
Year
End Date of Employment
Month
Day
Year
Name of Company
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Phone
Supervisor's Name
Position Held
Reason for Leaving
EMPLOYMENT #3
Start Date of Employment
Month
Day
Year
End Date of Employment
Month
Day
Year
Name of Company
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Phone
Supervisor's Name
Position Held
Reason for Leaving
This field is hidden when viewing the form
Resume Upload
Accepted file types: pdf, Max. file size: 50 MB.

Please upload your resume, if any.

Δ

Get in Touch

(714) 554-9700
(657) 212-4094
Email Us

Come On In

1929 North Fairview St
Santa Ana, CA 92706

Citrus Post-Acute

“We are Family Serving Families”
We achieve quality outcomes in all aspects of our organization through operational excellence, attracting and retaining top talent, and being socially responsible to the communities we serve.

Name
First Last
Phone
Email
Comments or questions:
CAPTCHA

Δ

© 2026 All Rights Reserved.

Site Map | Privacy Policy | Terms & Conditions | Web Accessibility | Client Login