Pitre Housing Residential Care – Employment Application
Thank you for your interest in joining Pitre Housing Residential Care. We are a provider supporting individuals enrolled in the HCS and TxHmL waiver programs. Please complete the application below, and a member of our team will contact you regarding next steps.
APPLICANT INFORMATION
Name
*
First Name
Last Name
Date-of-birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
POSITION & AVAILABILITY
Position Applying For:
*
Direct Care Staff (Respite / Attendant Care)
Personal Assistance Services
Community Support Staff
Availability:
*
Full-time
Part-time
PRN/ As needed
Preferred Work Schedule:
*
Weekdays
Evenings
Weekends
Flexible
EXPERIENCE
Do you have experience working with individuals with disabilities?
*
Yes
No
Describe your experience:
*
Do you have any of the following certifications?
*
RN/LVN
CNA
PPR/First Aid
Medication Aid
Other
TRANSPORTATION & RELIABILITY
Do you have reliable transportation?
*
Yes
No
Are you willing to transport clients if needed?
*
Yes
No
BACKGROUND & ELIGIBILITY
Are you at least 21 years old?
*
Yes
No
Are you willing to complete a background check?
*
Yes
No
Are you legally authorized to work in the United States?
*
Yes
No
DOCUMENT UPLOAD
Drivers License
*
Browse Files
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Choose a file
Cancel
of
Resume
*
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of
High school diploma or GED
*
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Choose a file
Cancel
of
Certifications (if applicable)
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Choose a file
Cancel
of
BACKGROUND CHECK CONSENT
I authorize Pitre Housing Residential Care LLC to conduct background screenings as part of the employment process.
Have you ever been convicted of a criminal offense that would prevent you from working with vulnerable populations (children, elderly, or individuals with disabilities)?
*
Yes
No
Please briefly explain:
Last 4 digits of SSN
*
Signature
*
Date
*
-
Month
-
Day
Year
Date
FINAL ACKNOWLEDGEMENT
I understand that submission of this application does not guarantee employment. All applicants must complete screening, background checks, and training requirements.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
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