Job Application For Adequate Cares

Job Application For Adequate Cares
1. Full Name*

First NameLast Name
2. Social Security Number:*
3. Address:*
4. Phone Number:*
5. Email:*
6. Are you 18 years old or older?*

YesNo
7. Position:*
8. When can you start?*

MonthDayYear
9. Desired Salary:*
10. Have you worked for this company before?*

YesNo
11. Who referred you to Adequate Cares LLC?*

FriendCoworkerAdvertisementInternetGovernment Placement AgencyOther
12. Are you currently employed?*

YesNo
13. May we contact your current employer?*

YesNo
14. Please list your current employers name & phone number, and also explain your reason for leaving.*
15. Are you eligible for employment in the United States?*

YesNo
16. Highest Level of Education:*

Some High SchoolHigh School Diploma or GEDSome CollegeAssociates DegreeBachelors DegreeOther
17. What professional training or certifications do you have?*
18. Please list any references you have and their contact information:*
19. Have you been convicted or charged with a felony within the past 5 years?*

YesNo
20. If yes, please explain:*
21. Please rate your physical condition: (5 being excellent)*

1

2

3

4

5

1 is , 5 is
22. Are you a licensed driver?*

YesNo
23. Will you travel 30 minutes one way?*

YesNo
24. Will you work every weekend?*

YesNo
25. Will you work every other weekend?*

YesNo
26. Will you work shifts at a hospital?*

YesNo
27. Will you work shifts at a nursing home?*

YesNo
28. Will you work private duty cases?*

YesNo
29. Check the times you are available:*

MorningAfternoonEveningNightOther
30. Check the days you are available*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
31. How many hours a week do you wish to work?*
Should be Empty: