New Hire Form

New Hire Form

Please fill out the form below if you are a newly hired employee with Guy Care Service.
Name*

First NameLast Name
Birth Date*

MonthDayYear
Any Alternative Names Used? Maiden Name, etc. Please put N/A if Not Applicable.*
Please use commas in between multiple names.
For Background Check Purposes:

Input your information carefully because this will be used to complete your background check.
Social Security Number*
Social Security Card or Birth Certificate*

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Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Driver's License Number*
ALL employees of Guy Care Service are required to have a Tennessee Driver's License or State ID. If you do not have this, you are required to obtain it within 30 days of being hired.
Please upload your Drivers License or State ID (Front side only)*

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CPR Certificate

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Active Car Insurance Policy

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Height*
Weight*
Natural Hair Color*
Eye Color*
Place of Birth (City and State or Country)*
Nurse License Number (if applicable)
Any Unlawful Conviction?*

YesNoN/A
Have you lived in another state within the last 5 years?*

YesNo
If YES, please list the state(s). Put N/A if Not Applicable*
If YES, please list the address(es) you most recently lived at for each state. Put N/A if Not Applicable.*
Education

Please fill out only the level of education you have completed.
Level of Education Completed*

High SchoolAssociate's DegreeBachelor's DegreeMaster's DegreeOther
High School Diploma/GED or College Transcripts*

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Are you Medication Administration Certified? *The Medication Administration Certificate with the state of Tennessee is valid for 3 years from the test date.*

Yes, I am Tennessee state certified and it is currently valid.No, but I was previously certified.No, but I am DCS medication certified through TN KEY MRI.I have never received a medication administration certificate.Not Applicable.
Please upload your Medication Administration Certificate if it is valid. Our HR department can also request the certificate from the state.

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Emergency Contact

Please list one emergency contact.
Full Name of Emergency Contact*
Phone Number of Emergency Contact*
Home Address of Emergency Contact*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature*

By signing, you hereby authorize that all of the information you have provided above is true and correct to the best of your ability.
Should be Empty:

New Hire Form

For Background Check Purposes:

Education

Emergency Contact