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Application Form

Application

Position
Position Type
How did you hear about us?

Section 1: Personal Information

Birthday
Month
Day
Year
Multi-line address

Section 2: Emergency Contact

Section 3: Legal Background

Are you authorized to work in the U.S.
Yes
No
Will you now or in the future require sponsorship for employment visa status (e.g., H-1B visa)?
Yes
No

Section 4: Criminal Background

Have you ever been convicted of a criminal offense?*
Yes
No

Section 4: Academic Information

Highest Level of Education Completed
Do you have a professional license?
Yes
No
Type of professional license (Select all that apply) *
Have you ever had a professional license suspended, revoked, or placed under investigation?
Yes
No
Are you currently or have you ever been subject to disciplinary action by a licensing or certifying body (e.g., State Board, employer, or regulatory agency)?
Yes
No

Section 5: Demographic & Background Information (Optional)

Are you a U.S. Military Veteran
Yes
No
I don’t wish to answer
Do you have a disability?
Yes
No
I don’t wish to answer
Gender
Male
Female
I don’t wish to answer
Race / Ethnicity (select all that apply)
Languages Spoken (check all that apply)

Section 6: Referrences *

Section 7: Documents *

Section 8: Scheduling Interview *

Do you prefer the interview via
Please pick a day and time
May 2026
SunMonTueWedThuFriSat
Week starting Sunday, May 10
Time zone: Coordinated Universal Time (UTC)Online meeting
Wednesday, May 13
10:00 AM - 11:00 AM
11:00 AM - 12:00 PM
12:00 PM - 1:00 PM
1:00 PM - 2:00 PM

Equal Opportunity & Non-Discrimination Statement

Vital Solution LLC is an equal opportunity employer. We are committed to creating an inclusive environment for all employees and applicants. Employment decisions are made without regard to race, color, religion, sex, gender identity or expression, sexual orientation, national origin, ancestry, age, disability, marital status, veteran status, genetic information, or any other characteristic protected by applicable federal, state, or local law.

Criminal Background Disclosure & Authorization

Vital Solution LLC may conduct background checks in accordance with applicable federal, state, and local laws. A criminal history does not automatically disqualify an applicant from employment. All relevant factors will be considered, including the nature and gravity of the offense, the time that has passed since the offense or completion of the sentence, and its relevance to the responsibilities of the position.

By signing below, you authorize Vital Solution LLC to obtain consumer reports and/or investigative consumer reports for employment purposes, including but not limited to criminal background history, in compliance with the Fair Credit Reporting Act (FCRA) and applicable state laws. You understand that this authorization may be used to obtain such reports at any time during the hiring process and, if hired, during your employment, as permitted by law.

Applicant Acknowledgment & Consent

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false or misleading information may result in disqualification from consideration or termination of employment if discovered at a later date.

I acknowledge that I have read and understand the Equal Opportunity & Non-Discrimination Statement and the Criminal Background Disclosure & Authorization provided above. I voluntarily consent to the terms outlined and authorize Vital Solution LLC to conduct background checks as described.

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Telehealth Services

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HIPPA Compliance

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Licensed Professionals

Se Habla Español

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