Silver Home Care Employment Application

Personal Care Aide Employment Application
Thank you for your interest in a Personal Care Aide position with Silver Home Care!

We are a non-medical Home Care Agency that provides in home services to elderly and disabled residents of Bucks and Philadelphia Counties.

At Silver Home Care, our mission is to improve lives!

We value KINDNESS. We show RESPECT for others and we strive to act with INTEGRITY in all that we do.

We are seeking like minded individuals who are FRIENDLY and RELIABLE to help us achieve our mission.

If this sounds like you and you are over 18, have a high school diploma or GED and reliable transportation, we encourage you to click NEXT to apply.

Silver Home Care is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state or federal law. Should an applicant need reasonable accommodation in the application process, they should contact a company representative at 800-719-6912.
If you have a referral code, enter it here.
Not required

Personal Care Aide Employment Application

Minimum Requirements
REQUIREMENTS
- A sincere desire to serve the needs of the elderly and disabled
- 18 years or older
- High School Diploma or GED
Job duties include (but may not be limited to)
- Personal Care
- Medication Reminders
- Meal Preparation
- Laundry
- Housekeeping
- Appointments
- Shopping and Errands
This position involves working with fragile, vulnerable or otherwise dependent individuals in their own homes and under minimal supervision. Therefore, If you are offered a position, we will complete a full background check on you including:
- Drug Testing
- Criminal Records Check
- Child Abuse Clearance
- References (3)
- Proof of Residency
- Medicaid Exclusion List Check
- Social Security Number Verification
If you meet the requirements and agreee to the background checks above, please confirm below to proceed to the application.
I meet the requirements and agree to the background check*

Personal Care Aide Employment Application

Demographics
Full Name*

First NameMiddle NameLast Name
Home Phone (old)
Home Phone Number*
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Cell Phone old
Can we text?*

YesNo
Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail*
example@example.com
Are You Legally Eligible to Work in the US?*

YesNo
You must be legally eligible to work in the US
Years of Caregiving Experience*
Do You Have A Valid Drivers License and Vehicle Insurance?*

YesNo
Do You Have a Reliable Vehicle?*

YesNo
When Can You Start*

MonthDayYear
Date
What hours and days are you available?

Personal Care Aide Employment Application

Education
Highest Level of Education Completed*

GEDHigh School DiplomaAssociates DegreeBachelors Degree or higher
Please select all that Apply:*

I am a CNAI am a Nursing StudentNone of the Above
CNA Registration Number (If Applicable)

Personal Care Aide Employment Application

Employment History
Are you currently employed?*

YESNO
Current Employer*
Current Position*
Current Duties*
Start Date*

MonthDayYear
End Date (leave blank if still employed)

MonthDayYear
Current Pay Rate*
Current Supervisor*
Supervisor's Phone Number*
Supervisor's Email
By providing an email address here, you are authorizing us to contact this individual by email.
May We Contact?*

YesNo

Personal Care Aide Employment Application

Employment History
Previous Employer 1*
Name of Previous Employer
Position*
Duties*
Reason for Leaving?*
Ending Pay Rate*
Start Date*

MonthDayYear
End Date*

MonthDayYear
Supervisor*

First NameLast Name
Supervisor's Phone Number*
Supervisor's Email
By providing an email address here, you are authorizing us to contact this individual by email.
May we contact?*

YesNo
Would you like to add another employer?*

YESNO

Personal Care Aide Employment Application

Employment History
Previous Employer 2
Name of Previous Employer
Position
Duties
Start Date

MonthDayYear
End Date

MonthDayYear
Ending Pay Rate
Reason for Leaving?
Supervisor

First NameLast Name
Supervisor's Phone Number
Supervisor's Email
By providing an email address here, you are authorizing us to contact this individual by email.
May we contact?

YesNo
Would you like to add another employer?

YESNO

Personal Care Aide Employment Application

Employment History
Previous Employer 3
Name of Previous Employer
Position
Duties
Start Date

MonthDayYear
End Date

MonthDayYear
Ending Pay Rate
Reason for Leaving?
Supervisor

First NameLast Name
Supervisor's Phone Number
Supervisor's Email
By providing an email address here, you are authorizing us to contact this individual by email.
May we contact?

YesNo

Personal Care Aide Employment Application

Professional Reference
Would you like to provide additional professional references?

YesNo
Name

First NameLast Name
Company
Phone Number
Email
By providing an email address here, you are authorizing us to contact this individual by email.
May we contact?

YesNo
Add Another?

YesNo

Personal Care Aide Employment Application

Professional Reference
Name

First NameLast Name
Company
Phone Number
Email
example@example.com
May we contact?

YesNo

Personal Care Aide Employment Application

Authorizations
This authorization gives us permission to contact the references you have provided. Please read carefully.

I have applied for employment with Silver Home Care and have provided information about my previous employment. I authorize Silver Home Care to conduct a reference check with my present and/or previous employer(s). I understand that reference information may include, but not be limited to, verbal and written inquiries or information about my employment performance, professional demeanor, rehire potential, dates of employment, salary and employment history. My signature below authorizes my former or current employers and references to release information regarding my employment record with their organizations and to provide any additional information that may be necessary for my application for employment to Silver Home Care, whether the information is positive or negative. I knowingly and voluntarily release all former and current employers, references, and Silver Home Care from any and all liability arising from their giving or receiving information about my employment history or qualifications, and my suitability for employment with Silver Home Care.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

Clear
Please type your name here to confirm your signature

First NameLast Name

Personal Care Aide Employment Application

Personal Care Aide - Drug Test Consent
Successful completion of pre-employment drug testing is a requirement of employment with Silver Home Care. You have the right to refuse this testing but in doing so your application will will be denied. Drug testing will be administered following the completion of your interview if you have been offered a position. We will use an oral swab to collect your saliva to test for the presence of Cocaine, Marijuana, Opiates, Amphetamines, Methamphetamine, and Benzodiazepines. If you are prescribed any medications that may produce a positive result, please notify us in advance of the test. If you believe the results of the test are not accurate, you have the right to request a retest of the original sample at a licensed laboratory of your choice within 3 days.
Full Name*

First NameMiddle NameLast Name
I have read and understand the scope, method and policy stated above.*

YESNO
I agree to submit to an Oral Swab test to screen for the use of Cocaine, Marijuana, Opiates, Amphetamines, Methamphetamine, and Benzodiazepines.*

YESNO
I agree to submit to a drug and alcohol test in the event that I am involved in an accident or other incident where my actions/decisions or lack thereof are potentiallya contributing factor or if drug or alcohol use during work hours is suspected.*

YESNO
Date*

MonthDayYear
Date
Signature*

Clear
You must agree to a drug test by answering the above 3 questions with a "YES" in order to be eligible for employment

Employment Application

Personal Care Aide
Tell us how you heard about us and why you are interested in working for Silver Home Care*
What do you feel is the most important thing we should know about you?*
If you have a cover letter, resume or written references you may upload them here.

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NOT REQUIRED
Cancelof
If hired, the relationship between you and Silver Home Care is referred to as "employment at will". This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or Silver Home Care . No representative of Silver Home Care has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will", and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and the owner of Silver Home Care.
Acknowledgement of At Will Statement*

Clear
Please enter your name to confirm your signature

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty:

Personal Care Aide Employment Application

Personal Care Aide Employment Application

Personal Care Aide Employment Application

Personal Care Aide Employment Application

Personal Care Aide Employment Application

Personal Care Aide Employment Application

Personal Care Aide Employment Application

Personal Care Aide Employment Application

Personal Care Aide Employment Application

Personal Care Aide Employment Application

Personal Care Aide Employment Application

Please provide at least three references who are NOT related to you. Each should have known you for at least 2 years and be able to attest to your character and suitability for this position. Two positive references are a condition of employment.

Personal Care Aide Employment Application

Personal Care Aide Employment Application

Employment Application