• 1st Choice Home Care Services

    1st Choice Home Care Services

  • Application For Employment

    All prospective employees will receive consideration without discrimination because of race, color, creed, age, natural origin, or handicap. All information provided herein will be kept confidential.
  • Sex?*
  • Race?*
  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Have you every applied for employment with this Agency?*
  • Are you legally eligible for employment in the United States?*
  • How did you learn of our organization?*
  • Are you a smoker?*
  • Do you have any fear or allergies of pets?*
  • Do you have a valid driver's license?*
  • Do you have your own vehicle?*
  • Do you have vehicle insurance?*
  • Rows
  • Have you been vaccinated against COVID-19?*
  • Rows

  • Work History

    List the last 3 years of employment history, starting with the most recent employer.
  • Have you had any pervious Aliases or Alternate names ?*
  • Are you currently employed?*
  • Do you have reliable transportation/the ability to reach multiple clients?*

  • Two (2) Professional / Personal Reference Check

  • Have you ever been convicted of a misdemeanor or felony crime in the past 5 years?*
  • Position applying for?*
  • Are you capable of performing the job set forth in the job description?*

  • I certify that the facts contained in this application are true and complete to the best of my knowledge and understand, that, if employed, falsified statements on this application SHALL BE GROUNDS FOR DISMISSAL.

     

  • I* * authorize complete investigation of all statements contained herein and herby give my full permission for the Agency to contact and fully discuss my background and history with all persons and entities listed above to give the Agency all information concerning my previous employment and any information they may have, and release all former employees and others listed above from all liability for any damage that my result from furnishing the same to the Agency.
     

    I understand and agree that, if hired, my employment is for no definite period, regardless of the date of payment of my wages and salary, be terminated at any time for any lawful reason, without prior notice and with or without cause.
     

    This application for employment shall be considered active for a period not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time shall inquire as to whether or not applications are being accepted at that time

  • Date*
     - -
  • Should be Empty: