Employment Application

  • HANFORD HOME HEALTH

    Employment Application

  • 1950 Keene Rd Bldg M Richland, WA 99352
    Phone: (509) 302-5770
    Secure Fax: 1-855-395-0854
    Email: office@hanfordhomehealth.com

    Please complete the entire application below. It is the policy of Hanford Home Health to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, sexual orientation, national origin, age, disability, or veteran status.

  • Demographics

  • Format: (000) 000-0000.
  • May We Text You at this Number?*

  • Which language(s) do you speak with proficiency?*

  • Emergency Contact(s)

  • Format: (000) 000-0000.
  • Are you 18 years or older?*
  • Are you legally eligible to be employed in this country?*
  • Have you applied to Hanford Home Health previously?*
  • Have you been employed at Hanford Home Health before?*
  • Were you referred by someone to work with us?*
  • Number of hours per week desired?*
  • Desired shifts?*
  • Date available to start at desired employment level?*
     / /
  • If hired, do you consent to driving record requests every two years and as needed?*
  • Do you have reliable transportation to and from work?*
  • Do you own a vehicle in good working condition that is suitable for transporting clients?*
  • If considered for hiring, will you agree to provide proof of vehicle insurance and maintain vehicle insurance throughout employment?*
  • Current Expiration Date*
     - -
  • Are you willing to travel 15 miles to/from work if needed?*
  • Have you been convicted of a misdemeanor or felony, or are you currently out on bail, the subject of a current warrant for arrest or released on your own recognizance pending trial?*
  • If hired, will you agree to random drug, alcohol, and criminal background checks?*
  • What is the highest level of education you have completed?*
  • Which professional licensure/certification do you currently hold?*
  • Do you currently hold a valid, unencumbered license or certification for your profession that is free from any restrictions, disciplinary actions, or conditions?*
  • If yes, current expiration date?*
     / /
  • Do you have a valid BLS/CPR certification?*
  • If yes, current expiration date?*
     / /
  • Do you have a valid Food Workers Card?*
  • If yes, current expiration date?*
     / /
  • Are you physically able to perform competently and safely all Caregiver tasks including but not limited to lifting 50 lbs. or more?*
  • Are you available to work past your scheduled shift and/or unscheduled hours if required for emergent situations?*

  • Resume Submission
    Please upload a current copy of your resume that outlines your employment history, including relevant positions, responsibilities, dates of employment, and any applicable certifications or accomplishments. Your resume should reflect your most recent and past work experience to help us better understand your qualifications.

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Policy Agreement
    I, the undersigned, certify that all the information I have provided is true, complete, and correct. I also understand that the information contained within this application or any cover letter or resume attached will not be shared by the company with any third parties. The information is used by the company only as an aid in the hiring decision making process. I, the applicant, by signing the application, give the company consent to collect the information contained herein and to use it for the purpose specified. I authorize company to investigate all statements contained in this application, including checking employment references. I understand that any misrepresentation or omission of facts called for is cause for immediate disqualification and/or if employed, immediate dismissal. I understand that if I am hired, I will be required to provide a criminal background check at my cost, proof of identity and legal authority to work in the United States of America, proof of certifications or educational qualifications, and a drivers license (if applicable). Furthermore, I understand and agree that if employed, I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same rights to terminate my employment at any time, with or without prior notice, except as may be required by law. I understand that this application does not in any way constitute an agreement or contract for employment.

    I have read, and consent to, the above policies and conditions.

  • Refrences

    Please provide at least two professional references whom we may contact to verify your qualifications and work history. These individuals should be people you have worked with in a professional setting, such as supervisors, managers, or colleagues. Do not include family members or personal friends.

  • Professional Reference #1

  • Format: (000) 000-0000.

  • Professional Reference #2

  • Format: (000) 000-0000.

  • Consent for Reference Check

    I, the undersigned, give my above named current/former employer(s) authorization to provide a reference check to my potential employer. I am aware and acknowledge the information referred to in my employment application is not shared with any third parties. By signing below I give the employer(s) consent to collect the information contained herein and use for the purpose specified.
  • Date*
     / /
  • Should be Empty: