• Image field 5

  • Application for Employment

    Cherry Blossom Home Care, LLC • O: (301) 249-1651 C: (240) 651-9009 F: (301) 249-1651
  • Date*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Referred to us by:

  • Gender*
  • Format: (000) 000-0000.
  • Position(s) applied for:*
  • Date available:*
     - -
  • Type of employment desired:*
  • If currently employed, may we contact your employer?*

  • Rate of Pay Expected $* per hour.

  • Is there a specific reason you are applying for employment at this company?*
  • Are you legally eligible for employment in this country?*
  • Are you available to work overtime if required?*
  • Have you applied with this company before?*
  • Have you been employed at this company before?*
  • Do you have any friends or family employed at this location?*
  • Have you ever been convicted of a crime?*
  • Have you been convicted of a crime in the last seven (7) years?*
  • If considered for hiring, will you agree to provide a criminal background check?*
  • If considered for hiring, will you agree to provide a drivers abstract?*
  • Do you have a valid driver’s license?*
  • Do you have current automobile Insurance?*
  • Are you willing to transport clients?*
  • Computer knowledge: Send/Receive emails, website, check schedule and obtain client info?*
  • Can you work in homes with pets (Cats/Dogs)?*

  • EDUCATIONAL BACKGROUND

    List previous three (3) educational institutions attended, beginning with the most recent.
  • GRADUATED?*
  • GRADUATED?*
  • GRADUATED?*
  • Valid in Maryland ?*
  • Do you have the following: CPR*
  • Do you have the following: First Aid*

  • EMPLOYMENT BACKGROUND

    Provide the following information beginning with the most recent employer.
  • Format: (000) 000-0000.
  • MAY WE CONTACT FOR REFERENCE?*
  • Format: (000) 000-0000.
  • MAY WE CONTACT FOR REFERENCE?*
  • MAY WE CONTACT FOR REFERENCE?*

  • REFERENCES

    List the name, relationship, number of years acquainted, and phone number of three references. (No relatives please
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • We rely on our staff to work regular, consistent shifts with the same clients and our positions are considered “PRN”. When offered shifts, our staff are able to accepts or decline each assignment. However, once accepted, it is just like any other job and you are expected to be there as agreed upon. 

  • Days/hours available to work:

  • Rows

  • I certify that all the information I have provided is true, complete and correct. The information contained within this application or any cover letter or resume attached is not shared with any third parties. The information is used by the employer only as an aid in the hiring decision making process. The applicant, by signing the application gives the employer consent to collect the information contained herein and use for the purpose specified. I authorize this company to investigate all statements contained on this application. I understand that any misrepresentation or omission of facts called for is cause for immediate disqualification and/or if employed, immediate dismissal. I understand that if I am hired, I will be required to provide criminal background check at my cost, proof of identity and legal authority to work in Canada, proof of certifications or educational qualifications, and a drivers abstract (if applicable). Furthermore, I understand and agree that if employed, I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same rights to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not in any way constitute an agreement or contract for employment.

  • Date*
     - -
  •  
  • Should be Empty: