Kenan Home Care LLC Job Application

1
Name* This field is required.
First Name
Last Name
2
Date of Birth
Date
Year
Month
Day
3
Address* This field is required.
Street Address
Street Address Line 2
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Country
4
Phone Number* This field is required.
Please enter a valid phone number.
5
Email* This field is required.
example@example.com
Confirm Email
6
Position applying for:* This field is required.
Sitter
Personal Care Assistant (PCA)
Activity Assistant
Certified Nursing Assistant (CNA)
Administrator/RN
Patient Transportation Driver
Housekeeping
7
Do you have a First Aid/CPR Certificate?* This field is required.If YES, you will have to upload in the next step.
YESNO
8
First Aid/CPR Certificate File UploadIf NO, please skip this step.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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9
Certification Registration #:If NO, please skip this step.
10
Expiration Date:If NO, please skip this step.
Date
Month
Day
Year
11
Did you graduate High School or receive a GED?* This field is required.
YESNO
12
What high school did you attend?* This field is required.If you received a GED, put N/A.
13
Have you attended any other universities or other post-secondary institutions?* This field is required.
YESNO
14
Name of College or University:* This field is required.If you did not attend a college or university, put N/A.
15
Did you graduate?* This field is required.
YESNO
16
Degree Received:
Associate Degree
Bachelor's Dergee
Master's Degree
Doctorate Degree (PhD)
17
Upload Resume
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Job 1* This field is required.
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Job 2* This field is required.
20
Job 3* This field is required.
21
Do you currently hold a Driver's License?* This field is required.
YESNO
22
Driver's License Number* This field is required.
23
State of Issued License:* This field is required.
24
License Expiration Date:* This field is required.
Date
Month
Day
Year
25
What is your current mode of transportation?* This field is required.
Car
Truck
SUV
Other
26
Will you be willing to provide a driving record?* This field is required.
YESNO
27
Any driving accidents in the past three years?* This field is required.
YESNO
28
If yes, please explain and provide how many driving accidents you have been involved in.* This field is required.If NO, please put N/A.
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Large
Normal
Small
Ok
Ok
29
Any driving violations in the past three years?* This field is required.
YESNO
30
If yes, please explain and provide how many driving violations you have been involved in.* This field is required.If NO, please put N/A.
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Large
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Small
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Ok
31
Check the technology devices that you use:* This field is required.
Cell
Computer
Tablet
32
Do you have a data plan on your mobile device?* This field is required.
YESNO
33
Will you be willing to fill out a caregiver daily checklist after each visit?* This field is required.
YESNO
34
What days are you available to work?* This field is required.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
35
What shifts are you available to work?* This field is required.
Morning
Afternoon
Evening/Night
Overnight
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How many hours can you work weekly?* This field is required.
4-16
16-20
26-40
37
If needed, are you available to work overtime?* This field is required.
YESNO
38
Can you work holidays?* This field is required.
YESNO
39
On what date can you start working if you are hired?* This field is required.
Date
Month
Day
Year
40
Have you ever applied to or worked for Kenan Home Care LLC before?* This field is required.
YESNO
41
If YES, when?* This field is required.If NO, please put N/A.
42
Do you have any friends, relatives, or acquaintances working for Kenan Home Care LLC?* This field is required.
YESNO
43
If YES, state name and relationship:* This field is required.If NO, please put N/A.
44
Are you a U.S. citizen or approved to work in the United States?* This field is required.
YESNO
45
Will you consent to a mandatory controlled substance test?* This field is required.
YESNO
46
Do you have any condition which would require job accommodations?* This field is required.
YESNO
47
If YES, please describe accommodations required below.* This field is required.If NO, please put N/A.
48
Have you ever been convicted of a criminal offense (felony or misdemeanor)?* This field is required.
YESNO
49
If YES, please state the nature of the crime(s). Please also state when and where convicted and disposition of the case:* This field is required.(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.) If NO, please put N/A.
50
Reference 1* This field is required.(No Relatives)
51
Reference 2* This field is required.(No Relatives)
52
Reference 3* This field is required.(No Relatives)
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How did you hear about this position?* This field is required.
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Applicant's Signature* This field is required.I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts is cause for dismissal at any time without any previous notice. I hereby give the employer permission to contact schools, previous employers (unless otherwise indicated), and references. This is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual, orientation, national origin, citizenship, or age. We assure you that your opportunity for this employment position depends solely on your qualifications.
Clear
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Applicant's Full Name:* This field is required.
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Today's Date* This field is required.
Date
Month
Day
Year
57
Please verify that you are human* This field is required.
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