MORE HEALING CARE APPLICATION

1
Non-Medical Homemaker position with More Healing Care LLC.* This field is required. This position is limited to non-medical services only. If this does not align with your expectations, please do not continue this application. Please confirm that you understand this position involves non-medical in-home support services only and does not include medical, clinical, or skilled nursing care.
Yes
No
2
Full Legal Name* This field is required.Enter your full legal name as it appears on your government-issued photo identification. This information will be used for employment eligibility verification, background screening, and personnel records.
Prefix
First Legal Name
Legal Last Name
3
Age Eligibility Confirmation* This field is required.Are you at least 18 years of age?
Yes
No
4
Email Address* This field is required. Provide a valid email address where you can receive employment-related communications, including application status updates, interview scheduling, and onboarding instructions.
Email Address
Confirm Email
5
Primary Phone Number* This field is required.Enter a valid phone number where you can be reached regarding your application. This number may be used for interview scheduling and employment-related communication.
Please enter a valid U.S. phone number, including area code.
6
Residential Address* This field is required.Please enter your current residential address. This information is used for employment records, background screening, and service assignment purposes.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Position Applied For* This field is required.Select the position for which you are applying with More Healing Care LLC.
Select a position
Select a position
Homemaker / Caregiver (Non-Medical)
Companion Caregiver
Personal Care Assistant (Non-Medical)
Respite Care Provider
Live-In Caregiver (If Applicable)
PRN / On-Call Caregiver
Other (Please Specify)
Position Applying For
8
Highest Level of Education This information is collected for personnel recordkeeping purposes only. Educational attainment is not a condition of employment for non-medical caregiver positions and will not be used as the sole basis for hiring decisions.
Please Select
Please Select
• Less than High School
• High School Diploma or GED
• Some College (No Degree)
• Associate Degree
• Bachelor’s Degree
• Graduate or Professional Degree
9
Educational Institution Attended Please provide the name of the educational institution you attended. This information is collected for employment records and qualification review purposes only.
10
Year of Graduation or Last Attendance If applicable, enter the year you completed or last attended the educational program listed above. This information is collected for employment records and qualification review only.
11
Employment Preference* This field is required.
Full-Time
Part-Time
PRN / As Needed
Flexible / Open Availability
12
Days Available to Work* This field is required. Availability information is used for scheduling purposes only and does not guarantee hours, shifts, or assignments.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Weekend Availability
Holiday Availability
13
Time of Day Available* This field is required.
Morning
Afternoon
Evening
Overnight
14
Additional Availability Notes
15
Work Experience Summary (Brief Description)* This field is required.Brief description of prior non-medical caregiving or support experience (Do not include medical diagnoses or protected health information)
Example: Provided companionship, meal preparation, light housekeeping, and assistance with daily activities for older adults and individuals with disabilities. Approximately 2 years of experience in non-medical home care and support roles.
16
Caregiver Experience Level (Years in Home Care or Related Support Roles)* This field is required. Enter the total number of full years of experience you have providing paid non-medical home care, personal assistance, homemaker services, companionship, or similar support roles. Include both agency-based and private caregiving experience. Do not include unpaid or informal experience unless it is relevant.
e.g., 1, 2, 5
17
Upload Resume (Optional) If available, please upload a current resume outlining your work history and relevant experience. Submission of a resume is optional and does not replace completion of all required sections of this application.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Accepted formats: PDF, DOC, or DOCX (maximum 10 MB).
Cancelof
18
Reference NamePlease provide the full name of a professional or personal reference who can speak to your work history, reliability, or character. Do not list family members.
Please list a professional or personal reference who can speak to your work or character.
19
Reference RelationshipPlease indicate how you know this person (e.g., supervisor, coworker, client, teacher). Family members should not be listed as references.
Relationship to you
20
Reference Contact InformationPlease provide at least one way to contact this reference (phone number and/or email address).
At least one method of contact is required (phone or email).
21
NON-MEDICAL TASKS YOU ARE WILLING TO PERFORM Selection does not guarantee assignment. Services must align with agency policy and client care plans.
Personal Care Assistance (bathing, grooming, dressing)
Activities of Daily Living (ADLs)
Mobility Assistance
Transfer Assistance
Companionship
Emotional Support
Dementia / Alzheimer’s Support
Medication Reminders (non-medical only)
Meal Preparation
Feeding Assistance
Light Housekeeping
Home Safety Observation
Reporting Changes in Client Condition
Infection Control Practices
Personal Hygiene Support
Client Dignity & Respect
Privacy & Confidentiality
Following Care Plan Instructions
Documentation & Shift Notes
Safety Awareness & Fall Prevention
Transportation Assistance
Cultural Sensitivity
Independent Work in Client Homes
Other (please specify)
Other
22
Professional Skills & Strengths* This field is required. Purpose: HR evaluation (separate from tasks) Checkbox list:
Communication Skills
Interpersonal Skills
Compassion and Empathy
Teamwork and Collaboration
Problem-Solving Skills
Time Management
Reliability and Punctuality
Attention to Detail
Client Support and Personal Care Assistance (non-medical)
Household Support (cleaning, meal preparation, errands)
Documentation and Record Keeping
Technology and Mobile App Use (EVV, scheduling, communication tools)
Conflict Resolution
Leadership or Supervisory Experience
Other (please specify)
Other
23
Acknowledgment of Non-Medical Services and Employment Conditions By continuing this application for employment, I understand and acknowledge that More Healing Care LLC provides non-medical in-home support services only and does not provide medical, clinical, or skilled nursing care.
I further acknowledge that, if hired, I may be assigned to provide services within designated service areas based on agency operational needs, client care plans, and my stated availability. 

 I understand that service assignments, schedules, hours, and locations are not guaranteed and may change based on agency operations, client needs, and program requirements. 

I understand that services may be provided across designated service areas, including but not limited to Cook, DuPage, Will, Kane, Lake, DeKalb, Grundy, Kendall, and McHenry Counties, based on client needs, availability, and agency operations. 

I acknowledge that no services may be rendered until all required employment documentation, acknowledgments, background clearances, credentialing, and training requirements have been fully completed, reviewed, and approved in accordance with agency policy and applicable federal, state, and program regulations. 

I further acknowledge that submission of this application does not guarantee employment and that any offer of employment is contingent upon successful completion of all required hiring, screening, training, credentialing, and compliance requirements established by More Healing Care LLC and applicable regulations.Read-only acknowledgment
24
I Acknowledge * This field is required.The Acknowledgment of Non-Medical Services and Employment Conditions I acknowledge that I have read and understand the above employment conditions and that submission of this application does not guarantee employment with More Healing Care LLC.
Yes
No
25
Acknowledgment of Non-Medical Services, Employment Conditions, and Job Requirements By continuing this application for employment, I acknowledge and understand that More Healing Care LLC provides non-medical in-home support services only and does not provide medical, clinical, or skilled nursing care.
I further acknowledge that, if hired, I may be assigned to provide services within designated service areas based on agency needs, client care plans, and my stated availability. 

I understand that service assignments, schedules, hours, and locations are not guaranteed and may change based on operational requirements. 

I understand that no services may be rendered until all required documentation, acknowledgments, background clearances, training, and onboarding requirements have been completed, reviewed, and approved in accordance with agency policy and applicable regulations. 

I acknowledge that submission of this application does not guarantee employment and that any offer of employment is contingent upon meeting all hiring, screening, training, and compliance requirements established by More Healing Care LLC. 

If hired, I understand that I will be required to review and sign all mandatory acknowledgments, policies, and compliance documents prior to performing any non-medical home care services on behalf of More Healing Care LLC. 

I further acknowledge and understand that this position may require physical activity typical of non-medical in-home support services, including but not limited to standing, walking, assisting with errands, light housekeeping tasks, meal preparation, and other non-medical duties as assigned. Essential job functions may include providing non-medical in-home support services such as personal care assistance, companionship, light housekeeping, meal preparation, and related tasks in accordance with client care plans and agency policy.Read-only acknowledgment:
26
I Acknowledge * This field is required.The Acknowledgment of Non-Medical Services, Employment Conditions, and Job Requirements I acknowledge that I have read and understand the above employment conditions and that submission of this application does not guarantee employment with More Healing Care LLC.
Yes
No
27
Electronic Signature Acknowledgment* This field is required.By typing your full legal name below, you are providing your electronic signature and certifying that all information provided in this application is true, complete, and accurate to the best of your knowledge. You acknowledge that this electronic signature is legally binding and equivalent to a handwritten signature under applicable federal and Illinois law. You understand that any false, misleading, or omitted information may result in disqualification from employment consideration or termination if hired.
Clear
28
Signature Date* This field is required.Please enter the date on which you are electronically signing this employment application. This date confirms when your electronic signature was executed and acknowledged. * The signature date will be maintained as part of your employment record and used for verification and compliance purposes.
Signature Date
Month
Day
Year
Should be Empty: