Pre-Screening Intake Form

Pre-Screening Intake Form

Complete this form to start your application and prepare for your interview.
Applicant Information
Full Name

First NameMiddle 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
City, State, Zip Code
Eligibility, Qualifications, and Experience
Do you have a valid, unexpired CPR certification?
Do you have a valid, unexpired First Aid certification?
Do you have a valid driver’s license and an insured vehicle?
Highest Level of Education
List any active licenses, degrees, or care certifications
Years of Experience in Professional Care or Premium Hospitality
Employment Preferences
Desired Employment Status
Preferred Shifts
Background and Professional Statement
Have you ever been convicted of a crime in the past 5 years, barring employment in a Home Care and community support Agency?
Describe a time you went above and beyond to preserve a client’s personal routine, comfort, or lifestyle standards.
At Elevate Living Solutions, we practice strict discretion. What does "white-glove hospitality and professional boundaries" mean to you?
Please share any additional background information relevant to your application.
Uploads and Authorization
Resume (PDF or Word)

Cancelof
Supporting Certifications

Cancelof
Background Screening & Compliance Authorization
Consent
Signature
Date

MonthDayYear
Date
Contact Us
Plan ahead or need immediate assistance? Get in touch to arrange a free professional consultation.
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email
example@example.com
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Question / Comment
Should be Empty:

Pre-Screening Intake Form

Applicant Information

Eligibility, Qualifications, and Experience

Employment Preferences

Background and Professional Statement

Uploads and Authorization

Contact Us