Form
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Position Applying for
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Please Select
Caregiver – Day Shift (7:00 AM–7:00 PM)
Caregiver – Night Shift (7:00 PM–7:00 AM)
Caregiver – PRN
Driver
Assistant Coordinator
Availability
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Days and hours you are available to work
Education Level
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Please Select
High School Diploma / GED
Some College
Associate Degree
Bachelor’s Degree
Master’s Degree
Other
Caregiving or Relevant Experience
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Brief description of experience
Have you worked with Legend Comfort Care before?
*
Yes
No
Resume
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Desired Hourly Rate
Certifications if applicable
CNA
CPR
First Aid
Medication Aid
Other
Do you have reliable transportation?
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Yes
No
Do you have a valid driver’s license?
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Yes
No
Are you at least 18 years of age?
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Are you able to pass a background check
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If not, please explain below
Terms & Conditions
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I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that providing false information may result in disqualification or termination of employment.
I accept the terms and conditions of employment consideration.
Signature
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