Application Form

Thank you for your interest in Acuity Care Services, LLC is an Equal Opportunity Employer, dedicated to a policy of nondiscrimination in employment on any basis, including race, color, age, gender, marital status, political affiliations, religion, origin, the presence of non-job related medical condition or handicap, sensory disability or any other basis prohibited by federal, state or local law.


  1. If you don’t already have it; make sure to download Adobe Reader
  2. Save File onto your computer’s desktop or downloads folder (remember where it was saved to just in case you plan to fill it out later.)
  3. Open File with Adobe Reader and form and scroll down to the 2nd page.
  4. Fields that need to be filled out are highlighted in a light blue color.
  5. Click within the field of choice and type in your response.
  6. Once all has been completed Make Sure to Initial and Date the form as a way of “signing” the document. Without this the form cannot be accepted or processed.
  7. Once you have filled out the form and Initialed it Save the Form. File > Save
  8. Once file has been saved with your responses close out Adobe Reader and Email the form to .

You can also print the form out and fill out the form by hand. Once filled out you can email them to . Or – if it’s a possibility – you many bring the form into our office located at: 333 City Blvd West, Suite 1700, Orange, CA 92868.