• Halo Companions LLC

    EMPLOYMENT APPLICATION
  • An Equal Opportunity Employer
    We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other legally protected status.

  • POSITION INFORMATION

  • Date of Application:*
     - -
    2 digit month, 2 digit day, 4 digit year

  • PERSONAL INFORMATION

  • Format: (000) 000-0000.
  • Are you 18 years of age or older?*
  • Are you legally authorized to work in the U.S.?*

  • AVAILABILITY

  • Date Available to Start:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you available to work:*
  • Days Available:*
  • EDUCATION*
    Rows
  • LICENSES & CERTIFICATIONS*
    Rows
  • CPR/BLS Certified?*
  • Expiration Date:*
     - -
    2 digit month, 2 digit day, 4 digit year

  • EMPLOYMENT HISTORY Please list your most recent employment first.

  • Format: (000) 000-0000.
  • Dates Employed: From*
     - -
    2 digit month, 2 digit day, 4 digit year
  • To*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Dates Employed: From*
     - -
    2 digit month, 2 digit day, 4 digit year
  • To*
     - -
    2 digit month, 2 digit day, 4 digit year
  • REFERENCES Please list three professional references (not relatives).*
    Rows

  • Halo Companions LLC

    Care you can feel, faith you can trust.

  • Employment ApplicationPage 2 of 2

  • ADDITIONAL INFORMATION

  • Have you ever been convicted of a felony?*
  • Have you ever had a professional license suspended, revoked, or placed on probation?*
  • Are you currently the subject of any investigation by a licensing board?*
  • A "yes" answer does not automatically disqualify you from employment. We will consider the nature, date, and circumstances of the offense or action.

  • SKILLS & EXPERIENCE

  • Please check any of the following areas in which you have experience:*

  • AVAILABILITY & TRANSPORTATION

  • Do you have a valid driver's license?*
  • Do you have reliable transportation?*
  • Are you willing to travel within our service area for client visits, assessments, or supervisory visits?*
  • Are you available for on-call or emergency situations when needed?*

  • APPLICANT STATEMENT

  • I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that false, misleading, or omitted information may disqualify me from consideration for employment or may result in termination if discovered after employment.

    I authorize Halo Companions LLC to verify any and all information contained in this application, including but not limited to, employment history, references, education, credentials, licensure, and background information.

    I understand that employment with Halo Companions LLC is at-will, which means employment may be terminated at any time, with or without cause and with or without notice, by either the employee or the company.

    I also understand that a background check, drug screen, TB screening, and verification of professional licensure may be required as a condition of employment.

  • Date:*
     - -
    2 digit month, 2 digit day, 4 digit year

  • FOR OFFICE USE ONLY

  • Date Received:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Interview Date:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Position:
  • Hire:
  • Start Date:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Background Check:
  • Drug Screen:
  • License Verified:
  • Should be Empty: