• Application For the Registry

    as an Independent Contractor

  • Thank you for your interest in working with Silver Lining Home Health Care, Inc.

    It is our sincere attempt to make the application process as simple as possible.
    If you have any questions, or need help in any way, please don't hesitate to call us.
    215-885-7701.

    In order to be considered for our Registry, you must complete the below application and be able to provide the following Before an interview will be scheduled:

    Application Check List
       1. Completed this Application
       2. Social Security Card
       3. Goverment Issued Photo ID or Driver's License
       4. Proof of Car Insurance (if you have a car)
       5. Proof of Eligibility to Work in U.S. 
       6. 2 years Proof of Residency
       7. Either a CNA License or Pass a Competency Test
       8. Current Criminal Background Check
       9. Current 2-Step PPD, Chest X-Ray, or QuantiFERON-TB Gold test
      10. Tuberculosis Survey Form

     

    If we feel you are a viable candidate and you meet our qualifications, we will schedule an in-person interview to see how we might work together.

  • Personal Information:

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Are You a U.S. Citizen?
  • Do you qualify to work in the U.S.?
  • Means of transportation?

  • Non American Citizens need to privide proof that they can legally work
    in the United States of America. 

  • A criminal background check is required by the Pennsylvania State Department of Health. Have you ever been accused of or convicted of a crime?
  • Do you have any restrictions that need to be considered when placing you on a case (allergies, lifting restrictions, etc.

  • Work Desired: Position: Direct Care Worker

  • Date You Can Start
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you PA State Certified?
  • Interested in:
  • Positioned interested in?
  • Are you currently employed?
  • May we contact your employer?
  • Have You Applied Here Before?
  • Have You Worked Here Before?

  • Education:

  • Employment:

    List 3 years of Direct Care Worker References, starting with the most recent.

  • Be sure to include the 3 years of work references, specifically in the nursing home and home health care industry. We require complete names, addresses and phone numbers. Additionally, we need your dates of employment. 
    If the client has died, please include the name and phone number of a family member that we may contact. 

  • Current Employment:

  • Start Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • May We Contact?

  • Previous Employment:

  • Start Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • May We Contact?

  • Previous Employment:

  • Start Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • May We Contact?

  • Skills/Qualifications:

  • Personal References:

    Give the name and the phone number of 3 persons who are not related to you. We prefer persons you have worked with and have known 2 years or more.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Cover Letter & Resume (Optional):

  • Upload a File
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    Choose a file
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  • Upload a File
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  • Send Application:

  • I, [Applicant's Name], hereby consent to the collection, use, and disclosure of my personal information provided in this Application for the Registry as an Independent Contractor for the purposes of evaluating my candidacy for work opportunities with [Company Name].

    I understand that the personal information collected on this form, including but not limited to my name, contact details, educational background, work experience, and any other information provided, will be used by [Company Name] for the following purposes:

    1. Reviewing and assessing my qualifications, skills, and suitability for work.
    2. Contacting me regarding potential job opportunities, interviews, and work-related matters.
    3. Verifying the accuracy and completeness of the information provided.
    4. Communicating with third-party references, educational institutions, and previous employers for the purpose of conducting background checks and verifying employment history.
    5. Complying with legal and regulatory requirements related to the recruitment and rostering process.

    I acknowledge that the personal information provided in this form will be handled in accordance with applicable privacy laws and [Company Name]'s privacy policy. I understand that my personal information may be stored, processed, and accessed by authorized personnel involved in the recruitment and rostering process.

    I further consent to [Company Name] retaining my personal information for a reasonable period following the completion of the recruitment process for future rostering opportunities, unless I withdraw my consent or request the deletion of my information.

    I understand that providing consent is voluntary, and I have the right to withdraw my consent at any time by contacting [Company Name]'s Human Resources department.

    By signing below, I confirm that I have read, understood, and consent to the collection, use, and disclosure of my personal information as described above.

  • Date Signed
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: