Bright Spot Home Care LLC Employment Application

What days and times are you available to work?

References (please provide names and contact information for at least one professional reference):
Do you have any healthcare certifications or licenses?
Please list your certifications or licenses (if any):
Do you have previous experience as a home healthcare aide or caregiver?
Describe your relevant work experience (include employer, dates, and responsibilities):

UPLOAD RESUME

Cancelof
REFERENCES
Professional Reference Name
First and Last
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Title & Organization
Professional Reference Name
First and Last
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Title & Organization
BACKGROUND CHECK CONSENT
IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK?
DISCLAIMER

PLEASE READ CAREFULLY
I understand that this organization is an Equal Opportunity Employer and is committed to maintaining a workplace that reflects diversity, equity, and inclusion. I acknowledge that my application must be fully completed in order to be considered for employment. I agree to provide complete, accurate, and truthful information in every section of this application.

I understand that any false, incomplete, or misleading information provided by me during the application or interview process may result in disqualification from further consideration or, if employed, termination of employment in accordance with Pennsylvania employment laws.

I further understand that, if hired, my employment will comply with all applicable federal and Pennsylvania state regulations governing employment practices.
Signature
Name

First NameLast Name
Should be Empty:

EDUCATION