Honey's Helping Hand Job Application

1. Are you comfortable working in a home with pets?*

YesAllergic to PetsNo. Please explain.

2. Are you comfortable working in a smoking household?*

YesNo. Please explain.

3. Are you willing to work in homes with security cameras or baby monitors present?*

YesNo. Please explain.

4. Do you have any physical limitations that would prevent you from assisting clients with mobility or transfers?*

NoYes. Please explain.

5. Do you have reliable transportation?*

YesNo

6. Are you willing to drive clients if required?*

YesNo

7. How far are you willing to travel for a shift?*

8. Are you comfortable providing care for:

9 Are there any client needs or conditions you are not comfortable assisting with?*

10 How would you handle a task outside your job duties?*

11 What would you do if you witnessed caregiver neglect?*

12. Are you open to last-minute or emergency shift assignments?*

YesNoOccassionally with notice

I certify that the information provided is true and complete. I authorize Honey's Helping Hand LLC to verify information and contact references as needed.

Submission of this application constitutes authorization for employment and reference verification.

I authorize Honey’s Helping Hand LLC to contact any current or former employer, supervisor, or professional reference that I have listed on this application, or otherwise provided, for the purpose of verifying my employment history, job title, dates of employment, duties performed, work performance, and eligibility for employment, to the extent permitted by law. I understand that this authorization applies regardless of whether the contact is made directly by Honey’s Helping Hand LLC or by a designated representative acting on its behalf. I release Honey’s Helping Hand LLC and any individual or organization providing such information from any and all liability arising from the release or use of this information in connection with my application for employment. This authorization shall remain valid throughout the hiring process and, if hired, during my employment, unless revoked by me in writing.*

Applicant Signature*

Date*

Date

Hour MinutesAM/PM Option

Equal Opportunity Statement

Honey’s Helping Hand LLC is an Equal Opportunity Employer. We do not discriminate against applicants or employees based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, military status, or any other protected characteristic under federal, state, or local law. All employment decisions are made based on qualifications, merit, and business needs.

Honey's Helping Hand

5 Year Work History

Employer #1

Employer #2

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Education History

Medical History

Professional References

Caregiving Preferences & Situational Questions