Stress Less Home Care Job Application

Stress Less Home Care

Employment Application
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact No.

Area CodePhone Number
E-mail
example@example.com
Date Available

MonthDayYear
Date
Social Security #
Desired Salary $
Position Applied for
Are you a citizen of the United States?

YesNo
If no, are you authorized to work in the U.S?

YesNo
Have you ever worked for this company?

YesNo
If yes, When?
ex. Feb-Apr 2020
Have you ever been convicted of a felony?

YesNo
If yes, Explain?
Education
High School
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you graduate?

YesNo
Diploma
College
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you graduate?

YesNo
Other
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you graduate?

YesNo
References

Please list three professional references.
Name

First NameLast Name
Relationship
Company
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name

First NameLast Name
Relationship
Company
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name

First NameLast Name
Relationship
Company
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Employment
Company
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor
Job Title
Starting Salary $
ex. 19,500
Ending Salary $
ex. 23,500
Responsibility
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Reason for leaving
May we contact your previous supervisor for a reference?

YesNo
Company
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor
Job Title
Starting Salary $
ex. 19,500
Ending Salary $
ex. 23,500
Responsibility
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Reason for leaving
May we contact your previous supervisor for a reference?

YesNo
Company
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor
Job Title
Starting Salary $
ex. 19,500
Ending Salary $
ex. 23,500
Responsibility
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Reason for leaving
May we contact your previous supervisor for a reference?

YesNo
I certify that my answers are true and complete to the best of my knowledge.

I authorize Stress Less Home Care to contact my previous employers and personal references for possible employment opportunities.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature

Clear
Should be Empty:

Stress Less Home Care

Education

References

Previous Employment