KCA Employment Application Step 1 of 4 25% KCA Employment Application *I Agree: As part of the process, KCA Firm, LLC requires this form to be completed and returned before the interview process can begin. All offers from KCA Firm, LLC clients are contingent upon receiving this Candidate Release and Background Information form and at least three (3) references.*I agree: Information gathered during this search my include information about my training, work history, education, previous work experience, malpractice claims, privileging and licensing information as well as criminal history and I release KCA Firm, LLC from any liability that may arise from the release of this information. I agree that I have read this disclosure and agree that KCA Firm, LLC may contact me regarding opportunities it represents. I understand I can request a copy of this paperwork by submitting a written request to [email protected] I agree that digital or photocopies of this information shall be accepted as the original.*I agree: I hereby consent to the Company’s verifying all the information I have provided on my application form. I also agree to execute as a condition of employment or a condition of continued employment any additional written authorization necessary for KCA to obtain access to and copies of records pertaining to this information. This includes gathering information from the Internet, past employers, and state boards. I authorize KCA Firm, LLC to verify any information contained on my curriculum vitae, background form and referencing paperwork. With regard to the foregoing disclosures, I hereby agree to release KCA Firm, LLC, including any person, company, or other entity from any and all causes of action that otherwise might arise. I understand that any false answers or statements, will be sufficient for rejection of my application or for my immediate discharge should such falsification or misrepresentations be discovered after I am employed.**Digital Signature Agreement. By checking this box I certify that I am the person completing this form and have typed my name below.Legal Name* First Last Current Job Title / Description*Date* Date Format: MM slash DD slash YYYY Preferred NameDate available to start your new position Date Format: MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Upload your resume or any other documents here Drop files here or What position are you applying for and what makes you qualified for this role?What about our company is most exciting to you?In your past experience, what was your favorite job & why? If this is your first job, what has been your favorite class in school & why?What were your best accomplishments in your last role? If this is your first job, please list your school accomplishments.What accomplishment are you most proud of in your personal or professional life?How many hours can you work weekly/ what shifts are you available?Are you able to commute to our location in a reasonable amount of time? Describe yourself in 5 words.Describe a time when you had to make a tough choice. What did you have to choose between and why did you choose it?Describe your relationship with your last immediate supervisor.What would your most recent supervisor have to say about you?Why did you move on, or why are you looking to move on, from your most recent position?Describe your ideal manager. Provide a short list of your personal strengths. They do not have to be job-related.Provide a list of your top 3 weaknesses.Provide a one or two-sentence glimpse of your primary career goal.If you would like to add anything else, please free to do so here.