Job Application

A Turning Pointe Family Solutions

Employment Application
Applicant Information
Name

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

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position Applying For

Other
Are you legally authorized to work in the U.S.?
Do you have a valid driver’s license?
Driver’s License Number
State Issued
Do you have reliable transportation?
Availability
Date Available to Start

MonthDayYear
Date
Availability (Check all that apply)
Background & Legal Status
Have you ever been convicted of a felony or misdemeanor?
If yes, please explain (include date, location, and details)
Are you currently on probation or parole?
Do you have any pending criminal charges?
Have you ever been listed on a caregiver or abuse registry?
Have you ever been terminated from a job for misconduct?
Work Experience
Most Recent Employer
Company Name:   Type a label
Position:   Type a label
Start Date   Date   / End Date:   Date
Supervisor Name   First Name   Last Name
Phone:   Area Code   Phone Number
Reason for Leaving:   Type a label
Previous Employer
Company Name:   Type a label
Position:   Type a label
Start Date   Date   / End Date:   Date
Supervisor Name   First Name   Last Name
Phone:   Area Code   Phone Number
Reason for Leaving:   Type a label
Previous Employer
Company Name:   Type a label
Position:   Type a label
Start Date   Date   / End Date:   Date
Supervisor Name   First Name   Last Name
Phone:   Area Code   Phone Number
Reason for Leaving:   Type a label
Upload Resume (optional)

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Skills & Experience
Do you have experience in home healthcare?
If yes, describe your experience
Certifications (check all that apply)

Other
If Other, describe your certifications
Do you have experience transporting clients?
Are you comfortable assisting with

Other
References
Reference #1
Name:   First Name   Last Name
Relationship:   Type a label
Phone Number:   Area Code   Phone Number
Email:   Email
Reference #2
Name:   First Name   Last Name
Relationship:   Type a label
Phone Number:   Area Code   Phone Number
Email:   Email
Emergency Contact
Name:   First Name   Last Name
Relationship:   Type a label
Phone Number:   Area Code   Phone Number
Email:   Email
Background Check Authorization

I understand that A Turning Pointe Home Care LLC may conduct a background check, including criminal history, driving record, and employment verification.
I authorize the company to obtain such information for employment consideration.
Disclaimer & Liability Waiver
I certify that all information provided in this application is true and complete to the best of my knowledge.
I understand that any false statements or omissions may result in disqualification or termination of employment.
I authorize A Turning Pointe Home Care LLC to verify all information provided, including contacting references and previous employers.
I release and hold harmless A Turning Pointe Home Care LLC, its employees, and representatives from any liability arising from background checks, reference checks, or employment verification.
I understand that submission of this application does not guarantee employment.
Signature
Date

MonthDayYear
Date
Should be Empty:

A Turning Pointe Family Solutions

Applicant Information

Availability

Background & Legal Status

Work Experience

Skills & Experience

References

Emergency Contact

Background Check Authorization

Disclaimer & Liability Waiver