1.1) Homemaker Job Application

Homemaker Job Application
As a Homemaker Services Worker (HSW) or Homemaker, you’ll provide non-medical, in-home assistance to seniors and individuals with disabilities—helping with light housekeeping, meal prep, errands, and daily activities to make their lives easier.
Applicant Demographic Information
Name*

First NameMiddle NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Gender*

MaleFemaleOtherPrefer Not To Answer
Race/Ethnicity*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a means of transportation to clients' homes?*

YesNo
If a current employee referred you, please state his or her name below

DISCLAIMER AND SIGNATURE

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false or misleading information provided during the application or interview process may result in my disqualification or dismissal if employed. I also authorize the agency to conduct a background check and to contact my previous employers for verification of employment history.
Full Name*

First NameMiddle NameLast Name
Signature*

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Homemaker Job Application