Chosen Hands Job Application

Chosen Hands in Home Care, LLC 524 Echo Woods Dr, Lancaster, South Carolina 29720

Chosen Hands in Home Care, LLC is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all the sections below:
Date of Application

MonthDayYear
Date
Applicant Name
Date of Birth

MonthDayYear
Date
SS
Address

Address

Street Address Line 2

City State and Zip CodeState / Province

Postal / Zip Code
Telephone Number
Email Address
example@example.com
Position(s) applying for: RN, LPN, CNA (PCA 2), PCA 1
Please Choose the position
How did you hear about this position
What hours or shift are you available for work
If needed are you available to work overtime
On what date can you start working if you are hired

MonthDayYear
Date
Do you have reliable transportation to and from work
Have you ever applied to or worked for Chosen Hands in Home Care, LLC before? Yes Or No

YesNo
If yes when
Do you have any friends, relatives, or acquaintances working for Chosen Hands in
Yes
No
If yes state name relationship
Are you 18 years of age or older? Yes Or No

YesNo
Are you a U.S. citizen or approved to work in the United States? Yes No

YesNo
What document can you provide as proof of citizenship or legal status
Will you consent to a mandatory controlled substance test?

YesNo
Do you have any condition which would require job accommodations?
Yes
No
If yes please describe accommodations required
Please list below the skills and qualifications you possess for the position for which you are applying
(Note: Chosen Hands in Home Care, LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional
Name
Location City State
Year Graduated
Degree Earned
Name
Location City State
Year Graduated
Degree Earned
Vocational School/Specialized Training
Name
Location City State
Year Graduated
Degree Earned
Military: Are you a member of the Armed Services? Yes No
Employer Name
Job Title
Supervisor Name
Address

Employer Address

Street Address Line 2

City State and Zip CodeState / Province

Postal / Zip Code
Employer Telephone
Dates Employed

MonthDayYear
Date
Reason for leaving
Employer Name
Job Title
Supervisor Name
Address

Employer Address

Street Address Line 2

City State and Zip CodeState / Province

Postal / Zip Code
Employer Telephone
Dates Employed

MonthDayYear
Date
Reason for leaving
Employer Name
Job Title
Supervisor Name
Address

Employer Address

Street Address Line 2

City State and Zip CodeState / Province

Postal / Zip Code
Employer Telephone
Dates Employed

MonthDayYear
Date
Reason for leaving
Please provide 3 personal and professional references below
The relationship between you and the Chosen Hands in Home Care, LLC is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Chosen Hands in Home Care, LLC. No representative of Chosen Hands in Home Care, LLC has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Administrator.
Applicant Signature

Clear
Dated

MonthDayYear
Date
Type a question
Type a question
Type a question
Type a question
Should be Empty: