Job Application For Adequate Cares
1. Full Name
*
First Name
Last Name
2. Social Security Number:
*
3. Address:
*
4. Phone Number:
*
5. Email:
*
6. Are you 18 years old or older?
*
Yes
No
7. Position:
*
8. When can you start?
*
/
Month
/
Day
Year
9. Desired Salary:
*
10. Have you worked for this company before?
*
Yes
No
11. Who referred you to Adequate Cares LLC?
*
Friend
Coworker
Advertisement
Internet
Government Placement Agency
Other
12. Are you currently employed?
*
Yes
No
13. May we contact your current employer?
*
Yes
No
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?
*
Yes
No
16. Highest Level of Education:
*
Some High School
High School Diploma or GED
Some College
Associates Degree
Bachelors Degree
Other
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?
*
Yes
No
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?
*
Yes
No
23. Will you travel 30 minutes one way?
*
Yes
No
24. Will you work every weekend?
*
Yes
No
25. Will you work every other weekend?
*
Yes
No
26. Will you work shifts at a hospital?
*
Yes
No
27. Will you work shifts at a nursing home?
*
Yes
No
28. Will you work private duty cases?
*
Yes
No
29. Check the times you are available:
*
Morning
Afternoon
Evening
Night
Other
30. Check the days you are available
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
31. How many hours a week do you wish to work?
*
Submit
Should be Empty: