Application for Employment

Application for Employment

Care by April
Application Date

MonthDayYear
Date
Name

First NameMiddle NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Are you 18 years of age?
If no, child labor laws may prohibit you from being hired
Are you able to present evidence of your U.S. Citizenship or proof of your legal right to work in the United States?
Do you have a vehicle that can be used to transport seniors?
Are you able to provide proof of auto insurance?
Have you ever been convicted of a criminal offense (felony or misdemeanor)?
If Yes, Please explain nature of crime(s), location, and date of conviction

Please indicate days and times available to work
Monday Availability

AM/PM Option

Until
until

AM/PM Option
Tuesday Availability

AM/PM Option

Until
until

AM/PM Option
Wednesday Availability

AM/PM Option

Until
until

AM/PM Option
Thursday Availability

AM/PM Option

Until
until

AM/PM Option
Friday Availability

AM/PM Option

Until
until

AM/PM Option
Saturday Availability

AM/PM Option

Until
until

AM/PM Option
Sunday Availability

AM/PM Option

Until
until

AM/PM Option
Type of Employment Desired
What is your expected pay?
Date Available to Start

MonthDayYear
Date
Are you available for overnights as needed?
Are you available to be on call?
Do you have any known allergies? (Pets, smoke, or others?)
Reason for interest in joining Care by April?
Do you have any other special training, experience, qualifications, or skills that would qualify you to work with seniors?
If Yes, Please Explain

Employment History

Please provide details of your most recent and previous employment. Include your last two employers and account for any periods of unemployment. Even if you have attached a resume, this section must be completed.
Employer Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Summary of Duties
Reason for Leaving
May we contact this Employer?
Employer Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Summary of Duties
Reason for Leaving
May we contact this Employer?

Education Background

Please list all schooling through the highest level of completion. Ex: high school, college, etc.
High School
School Attended
City/State
Graduate
Degree/Diploma Earned
College
School Attended
City/State
Graduate
Degree/Diploma Earned
Graduate School
School Attended
City/State
Graduate
Degree/Diploma Earned
Other Education or Certifications
School Attended
City/State
Graduate
Degree/Diploma Earned

Resume Upload and Application Submittal
Attach Your Resume Here (Optional)

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I certify that the answers given herein are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of fact, or incomplete answers in any application document will disqualify me from further consideration for employment. I further understand, if employed, any misrepresentations or omissions of facts in any application document will result in my dismissal without prior notice regardless of when such misrepresentation or omission is discovered.

I authorize Care by April to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and professional experiences with them, without giving me prior notice of such disclosure. In addition, I release Care by April, my former employers and all other persons, corporations, partnerships and association from any and all claims, demands or liabilities arising out of or in any way related to such examination or revelation.

By signing and submitting the employment application, I give my consent to Care by April to secure all job related information about me including, but not limited to, criminal background checks, motor vehicle checks, and credit checks (if applicable.)

I understand that if I am hired, my employment is not definite and can be terminated at any time either with or without cause and without prior notice, by either me or Care by April.

By signing below, you acknowledge that you have read and agree to the statement above.
Signature
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