CHHC Application for Employment
Pre-employment Questionnaire Equal Opportunity Employer. Please fill in your details below.
Personal Information
First Name
*
Last Name
*
SSN/TIN
*
Date of Birth
*
-
Month
-
Day
Year
Date
Present Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email Address
*
How did you hear about us?
*
Employment Desired
Position Desired
*
Date you can start
Salary Desired/Hourly
Are you currently employed?
*
Yes
No
Availability
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Back
Next
General Information
Subject of Special Study/Research Work
Driving
*
Yes
No
U.S Military of Naval Service?
*
Yes
No
Other Testimonial (e.g Certificates)
Upload your CV (Resume)
Upload your ID (e.g License)
*
Signature
*
Clear
Date
-
Month
-
Day
Year
Date
Screening Questions:
Do you have a caregiving experience?
*
Yes
No
If Yes, how many years?
Are you authorized to work in the U.S.?
*
Yes
No
Choose not to answer
Do you have the latest Flu shot?
*
Yes
No
DO you have the Covid-19 vaccine?
*
Yes
No
Do you have the following license or certification: Home Care Aide certification?
*
Yes
No
Are you willing to undergo a background check, in accordance with local law and regulations?
*
Yes
No
Can you work overtime if necessary?
*
Yes
No
Can you reliably commute to this job's location?
*
Yes
No
Are you bi-lingual? If Yes, what language?
*
How would you rate you communication skills?
1
2
3
4
5
Worst
Best
1 is Worst, 5 is Best
Submit CV
Should be Empty: