Thank you for your interest in LucasaCare BG, LLC or LucasCare East. Please fill out and submit the application below. If needed, a team member will reach out with next steps.

LucasaCare BG, LLC and LucasaCare East are Equal Opportunity Employers. We are committed to a workplace environment that encourages growth and respect for all current and prospective employees based upon job-related factors such as educational background, work experience, and ability to perform the essential functions of a particular job. It is the policy and practice of LucasaCare BG, LLC and LucasaCare East to prohibit any form of discrimination or harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, marital status, disability status, genetic information, protected veteran status, pollical affiliation or activity (if a public employee) or any other characteristic protected by applicable law. LucasaCare, BG LLC and LucasaCare East conform to the spirit as well as to the letter of all applicable laws and regulations. Support of and belief in this principle is a basic responsibility of all Agency employees.

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Name *

First

Middle

Last

Maiden Name (if applicable):

Home Phone *

Work Phone

Other Phone

Email *

Are you 18 or over? *

• Yes
• No

Title of Position Applying for and Date Available to Work *

Have you been previously interviewed by LucasaCare East?

• Yes
• No

If YES, list date(s) and job title(s)

Do you have any relatives currently working for LucasaCare East?

• Yes
• No

If YES, list names and relationship to you

Are you employed now?

• Yes
• No

If YES, may we contact your current employer?

• Yes
• No

What is the highest level of education you have completed? *Please SelectHigh School Diploma/GEDSome CollegeAssociate's DegreeBachelor's DegreeMaster's DegreeTechnical or Certificate Program

List the name and locations of all schools, number of years completed, major areas of study and degree/diplomas here:

EMPLOYMENT HISTORY: Employer Name (Please provide information of your last three employers, beginning with the most recent): *

Job Title and Dates of Employment *

Job Duties *

Employer Address *

Employer Phone Number *

Weekly Pay at Start of Employment:

Weekly Pay at End of Employment:

Reason for Leaving:

EMPLOYMENT HISTORY: Employer Name

Job Title and Dates of Employment:

Job Duties :

Employer Address:

Employer Phone Number:

Weekly Pay at Start of Employment:

Weekly Pay at End of Employment:

Reason for Leaving:

EMPLOYMENT HISTORY: Employer Name:

Job Title and Dates of Employment:

Job Duties:

Employer Address:

Employer Phone Number:

Weekly Pay at Start of Employment:

Weekly Pay at End of Employment:

Reason for Leaving:

Describe your qualifications for the type of employment you are seeking: (Please include skills, special training, etc)

Please describe your experience working with adults with disabilities:

Reference #1: (name of supervisors, managers, or others who can comment directly on your abilities)

Reference #1 Address and Phone Number:

Reference #1 Relationship/Occupation:

Reference #1 Years Known

Reference #2: (name of supervisors, managers, or others who can comment directly on your abilities)

Reference #2 Address and Phone Number:

Reference #2 Relationship/Occupation:

Reference #2 Years Known:

Reference #3: (name of supervisors, managers, or others who can comment directly on your abilities)

Reference #3 Address and Phone Number:

Reference #3 Relationship/Occupation:

Reference #3 Years Known:

Do you have a valid driver's license?

• Yes
• No

Driver's License Number and State Issued:

Do you have current vehicle insurance?

• Yes
• No

Insurance Name and Date of Expiration

Are you willing to undergo a background check in accordance with local law/regulations?

• Yes
• No

Are you willing to submit to a random drug screening?

• Yes
• No

Have you LIVED or WORKED outside of Kentucky within the last year?

• Yes
• No

If yes, which states have you lived in (past 12 months)?

By typing your name and submitting this application, you certify that the facts set forth in this application are true and complete to the best of your knowledge. You understand that if employed, false statements on this application shall be considered sufficient cause of dismissal. You authorize LucasaCare East to make investigations of your personal references and agree to a background check and drug screening.

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