• ABIDE HOME CARE AGENCYABIDE HEALTH SERVICES LLCDIRECT CARE WORKER / CAREGIVER EMPLOYMENT APPLICATION

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  • Equal Opportunity Employer
    Thank you for your interest in joining Abide Home Care Agency. Please complete all applicable sections. Submission of an application does not guarantee employment.

  • 1. APPLICANT INFORMATION

  • Format: (000) 000-0000.
  • Are you at least 18 years of age?
  • Are you legally authorized to work in the United States?

  • 2. POSITION INFORMATION

  • Position Applying For: Direct Care Worker / Caregiver
  • Date Available to Start:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Employment Desired:

  • 3. GENERAL AVAILABILITY

  • Circle all options that apply.Days Available:
  • Preferred Shift(s):
  • Available on Holidays?

  • 4. CAREGIVING EXPERIENCE

  • Do you have previous caregiving or direct care experience?
  • Select all caregiving skills/experience that apply:

  • ABIDE HOME CARE AGENCY

  • DIRECT CARE WORKER / CAREGIVER EMPLOYMENT APPLICATION - CONTINUED

  • 5. EDUCATION

  • Highest Level Completed:

  • 6. TRAINING & CERTIFICATIONS

  • Training & Certifications Checklist
  • Expiration Date:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Previous training or experience does not replace Abide Home Care Agency's required agency orientation, training, and competency evaluation before client assignment.

  • 7. EMPLOYMENT HISTORY

  • Format: (000) 000-0000.

  • 8. PROFESSIONAL REFERENCES

  • Please provide two references who are not related to you and who can speak to your reliability, character, work experience, or ability to provide home care services.
  • Reference #1
  • Format: (000) 000-0000.
  • Reference #2
  • Format: (000) 000-0000.

  • ABIDE HOME CARE AGENCY

  • 9. PRE-EMPLOYMENT REQUIREMENTS

  • You may submit this application even if you do not yet have all of the items listed below. If selected to continue in the hiring process, Abide Home Care Agency will provide instructions for completing or submitting the applicable pre-employment requirements. All required pre-employment documentation, screening, orientation, training, and competency requirements must be completed and documented before you are approved to begin providing services to a client.
  • Pre-Employment Requirements Checklist

  • DIRECT CARE WORKER / CAREGIVER EMPLOYMENT APPLICATION - CONTINUED

  • 10. APPLICANT QUESTIONS

  • ABIDE HOME CARE AGENCY

  • 11. APPLICANT CERTIFICATION & AUTHORIZATION

  • 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 materially incomplete information may result in disqualification from consideration for employment or appropriate employment action if discovered after hire.

    I authorize Abide Home Care Agency to verify information provided in this application, including contacting employers and references as permitted by law. I understand that submitting this application does not constitute an offer or guarantee of employment.

    If selected, I understand that I must satisfy Abide Home Care Agency's applicable pre-employment, orientation, training, competency, and documentation requirements before being approved for independent client assignment. I also understand that, if selected for employment, I am expected to perform my responsibilities to the best of my ability, work toward excellence in the care and services I provide, and uphold and embody Abide Home Care Agency's core values through my conduct, professionalism, and interactions with clients, families, coworkers, and others.

  • DIRECT CARE WORKER / CAREGIVER EMPLOYMENT APPLICATION - CONTINUED

  • FOR ABIDE HOME CARE AGENCY USE ONLY

  • APPLICANT: DO NOT WRITE IN THIS SECTION - ABIDE HOME CARE AGENCY ADMINISTRATOR / AUTHORIZED STAFF ONLY
  • Interview Date:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Face-to-Face Interview:
  • Two References Verified:
  • Proceed to Onboarding:
  • Rows
  • CONFIDENTIAL EMPLOYMENT DOCUMENT - Maintain in the applicant/employee personnel file in accordance with Abide Home Care Agency policy.
  • Date:
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Should be Empty: