Premier Legacy Care Employment Application
Apply for a caregiving position with Premier Legacy Care. Please complete all sections accurately.
Personal Information
Full Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
City & State
Are you authorized to work in the U.S.?
Yes
No
Caregiving Experience
Do you have caregiving experience?
Yes
No
Years of experience
Please Select
0-1
1-3
3-5
5+
Type of Experience
Elderly Care
Disability Support
Hospice Care
Personal Care
Previous Employer(s)
Certifications & Qualifications
CNA (Certified Nursing Assistant)
Yes
No
HHA (Home Health Aide)
Yes
No
CPR / First Aid Certified
Yes
No
Valid Driver’s License
Yes
No
Availability
Employment Type
Please Select
Full-Time
Part-Time
PRN
Preferred Shift
Day
Night
Overnight
Days Available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Pre-Screening Questions
Are you comfortable assisting with bathing and mobility support?
Yes
No
Are you able to lift at least 25-50 lbs?
Yes
No
Short Answer Questions
Why do you want to work with Premier Legacy Care?
Describe a time you provided compassionate care.
Documents
Upload Resume
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Certifications
Upload a File
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Submit Application
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