• ❏ NC Medicaid and VA enrolled Provider
  • ❏ Member Association for Home and Hospice Care of NC
  • ❏ Licensed by NC DHHS
  • ❏ Insured

Application for Employment

Lily Care, Inc.

50 State Street • Marion, NC 28752 • 1-800-977-8879

We are an equal opportunity agency, dedicated to a policy of non-discrimination on any basis including race, age, sex, religion, disability or national origin.

Basic Information


Work History

List previous employers. Please include as much information as possible.

May we run a detailed employment check, including but not limited to a check with your previous employers?
Personal References