Caregiver/Companion Employment Application

Caregiver/Companion Employment Application

Apply to join Annebenanne Cares Home as a luxury holistic non-medical companion caregiver in Florida.
Personal Information
Full Name

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employment History
Is this your current employer
Previous Employment
Have you ever been terminated or asked to resign from a position?
Highest Level of Education Completed
Criminal History Disclosures and Authorization

Criminal History & Regulatory Screening Notice Position Notice: This position requires direct care to vulnerable adults and/or children. In accordance with Section 435.04, Florida Statutes, and regulations by the Florida Agency for Health Care Administration (AHCA), all job offers are strictly conditional upon the successful completion of a Level 2 fingerprint-based criminal background check through the Care Provider Background Screening Clearinghouse. [1, 2, 3]
Question: Have you ever been arrested for and are awaiting final disposition of, been found guilty of (regardless of adjudication), entered a plea of guilty, or entered a plea of nolo contendere (no contest) to any of the specified disqualifying offenses listed under Section 435.04, Florida Statutes (including, but not limited to: violent crimes, fraud, theft, abuse, neglect, exploitation, or felony drug offenses) in Florida or any other jurisdiction?[1, 2][ ] YES[ ] NO If YES, please specify the charge(s), date(s), and jurisdiction. (Note: A prior offense does not automatically bar you from employment unless it is a legally disqualifying offense without an active AHCA Exemption from Disqualification). [1]
If yes, please explain (optional)
Annebenanne Cares is a luxury, non-skilled home care agency seeking professional companions to provide non-physical support only. Duties include companionship, conversation, light housekeeping, errands, and transportation. This role does not include any hands-on care (no lifting, bathing, or personal care). We are looking for individuals who are reliable, compassionate, professional, and attentive.
Do you understand and agree to the responsibilities of this non-physical companion role?
This role may require occasional transportation of clients in an agency vehicle. Do you possess a valid Florida driver’s license?
Are you currently CPR certified? Note: CPR certification is not required at the time of application. If not currently certified, training and certification will be provided by the agency upon hire.
Character References
Personal Reference
Professional Reference #1
Professional Reference #2
Describe a time you handled a stressful situation in a caregiving or home-care environment.
Why do you think you would make a good fit for Annebenanne Cares
Upload Your Resume (optional)

Cancelof
By submitting this application, I affirm that all information provided is true and accurate to the best of my knowledge. I understand that any false, misleading, or omitted information may be grounds for immediate disqualification from consideration or termination of employment if discovered after hire. I also understand that such misrepresentation may affect eligibility for unemployment benefits where applicable.
Should be Empty:

Caregiver/Companion Employment Application

Personal Information

Employment History

Criminal History Disclosures and Authorization

Character References