• APPLICATION FOR EMPLOYMENT

    APPLICATION FOR EMPLOYMENT

  • We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, gender, sexual orientation, disability, medical condition, national origin, or marital status.

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  • Emergency Contact

    Please provide the contact details of who you want us to contact in the case of an emergency
  • Transportation:

    Many caregiver positions require the caregiver to transport a client.
  • Availability

    What is your preferred schedule?
  • Education

  • Experience

  • Skills

    Please indicate whether you have assisted with or performed the following tasks for seniors.
  • Physical Ability

  • Employment History

    Please go back at least five years and tell us about your work history. If you don't have five years of work history list the history you do have.
  • Business References

    Please provide three business references. These can be a supervisor, work colleague, pastor, counselor, client, etc.
  • Personal References

    Please provide three personal references. These can be a family member, or friend.
  • CERTIFICATION AND RELEASE: I certify that I have read and understand the application note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentation of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

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  • Copyright 2021:  Almost Home Senior Care. All rights reserved.

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