JOB Application

JOB Application
Join Our Team at Best Care Home Health Agency!
Philadelphia USA
(215) 999-1883

Best Care Home Health Agency 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 a reasonable accommodation in the application process, he or she should contact a company representative. Please fill out all of the sections below
Applicant Information
Applicant Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Application*

MonthDayYear
Date
Employment Position
Position(s) applying for:*

Office ManagerStaffing ManagerRecruiterHome Health Aide
How did you hear about this position?*
What days are you available for work?*
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?*

YesNo
Salary desired:*
Personal Information
Do you have any friends, relatives, or acquaintances working for Best Care Home Health Agency*

YesNo
If yes, state name & relationship:*
Are you 18 years of age or older?*

YesNo
Are you a U.S. Citizen or approved to work in the United States?*

YesNoOther
What document, can you provide as proof of Citizenship or legal status? Identification and a Social Security Card*

Cancelof
Will you consent to a mandatory controlled substance test?*

YesNo
Do you have any condition which would require job accommodations?*

YesNo
If yes, please describe accommodations Required below.*
Have you ever been convicted of a criminal offense (felony or misdemeanor)?*

YesNo
If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:*
(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.)
Job Skills/ Qualifications
Please, upload your Resume for the post that you are applying for.*

(Note: Best Care Home Health Agency 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.
Cancelof
Education and Training
High School Name*
Location (City, State)*
Year Graduated*
Degree Earned*
College/ University Name*
Location (City, State)*
Year Graduated*
Degree Earned*
Vocational School/ Specialized Training*
Location (City, State)*
Year Graduated*
Degree Earned*
Military:
Are you a member of the Armed Services?*

YesNo
What branch of the military did you enlist?*
What was your military rank when discharged?*
How many years did you serve in the military?*
What military skills do you possess that would be an asset for this position?*
References

Please provide 1 personal and professional reference(s) below:
Reference*
Contact Information*
AT-WILL EMPLOYMENT

The relationship between you and the Best Care Home Health Agency 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 Best Care Home Health Agency. No representative of Best Care Home Health Agency 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 Executive Vice-President/Chief Operations Officer or the Company's President.
Applicant Signature*

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JOB Application

Applicant Information

Employment Position

Personal Information

Job Skills/ Qualifications

Education and Training

Military:

References