Join Our Compassionate Care Team
BellaCare Solution is committed to providing dignified, reliable, and compassionate care. We’re seeking dedicated caregivers and transport staff who are passionate about serving with integrity and excellence.
Applicant Information
Name
First Name
Last Name
DOB
-
Month
-
Day
Year
Date of Birth
Phone Number
Please enter a valid phone number.
Email
example@example.com
Preferred Method of Contact
Please Select
Phone
Text
Email
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you legally eligible to work in the U.S.?
Yes
No
Do you have a valid driver’s license?
Yes
No
Have you lived in North Carolina for the past 5 years?
Yes
No
Position Details
Position Applying For
Please Select
PCA - Not Certified
CNA - Certified
RN - Registered Nurse
Type of Employment Desired
Please Select
Full-time
Part-time
PRN/ As Needed
Available Start Date
-
Month
-
Day
Year
Certifications and Licensure
CNA Certification Number
Do you have First Aid/CPR Certification?
Yes
No
Experience
How many years of caregiving experience do you have?
Have you ever worked in home care or companion care before?
Yes
No
Briefly describe your past caregiving/transportation experience
Are you comfortable working with:
Elderly
Dementia
Hospice
Bedbound Clients
Pets in the Home
Smokers
References
Please provide 3 professional references.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Screening Questions
Do you have reliable transportation?
Yes
No
Have you ever been convicted of a crime?
Yes
No
If answered yes, above.
Are you willing to undergo a criminal background check and fingerprinting?
Yes
No
Are you willing to submit to a drug test?
Yes
No
Are you comfortable working under a female-owned business with high standards for quality and professionalism?
Yes
No
Required Documentation
File Upload
Browse Files
Drag and drop files here
Choose a file
Please upload drivers license, cpr certificate, any relevant certificates, resume.
Cancel
of
Availability & Preferences
Days of the Week , Availability ( Check all that apply)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred Shift
Day Shift 7a-3p
Evening Shift 3p-11p
Overnight Shift 11p-7a
Live In
Are you comfortable with occasional weekend or holiday shifts?
Yes
No
Are you available on-call or short-notice?
Yes
No
Emergency Contact
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Relationship to You:
Acknowledgments & Signature
Statements:
I certify that all information provided is true and complete.
I authorize BellaCare Solutions to conduct background checks and contact references.
I understand this application does not guarantee employment.
I understand that any false information may result in termination if hired.
Typed Full Name
Date
-
Month
-
Day
Year
Date
I agree to the above terms and statements.
Yes
Submit
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