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A Plus Senior Care
Thank you for your interest in working for our agency. Please submit the application below to be considered for a position as a caregiver.
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1
Full Name
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First Name
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2
Address
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Street Address
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City
State / Province
Postal / Zip Code
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United States
Afghanistan
Albania
Algeria
American Samoa
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Anguilla
Antigua and Barbuda
Argentina
Armenia
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Australia
Austria
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The Bahamas
Bahrain
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Belgium
Belize
Benin
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Bolivia
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Botswana
Brazil
Brunei
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Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
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Chad
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China
Christmas Island
Cocos (Keeling) Islands
Colombia
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Cook Islands
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Cote d'Ivoire
Croatia
Cuba
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Denmark
Djibouti
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Estonia
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Faroe Islands
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France
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Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
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Greenland
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Guadeloupe
Guam
Guatemala
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Guinea
Guinea-Bissau
Guyana
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Indonesia
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Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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3
Phone Number
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Area Code
Phone Number
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4
E-mail
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5
Hours Wanted Weekly?
How many hours would you like to work per week.
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6
Match Criteria
Please select checkboxes that match your skills and preferences.
Dementia Experince
Insured Automobile
Hospice Experience
Live In Shifts ( OK )
Incontinence Experience
Gait Belt Experience
Hoyer Lift Experience
Ok WIth Cats
Ok With Dogs
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7
Maximum Client's Weight For Transfers?
In Your Experience...
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8
Education
Did You Attend High School ?
YES
NO
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9
Name of School?
If yes, Name of the High School You attended.
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10
Training
Did You Attend College?
YES
NO
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11
Name of College?
If yes, Name of the College You attended.
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12
Certification & Credentials
Enter All That Apply
Background Check
Expiration Date
Car insurance
Expiration Date
Care Giver Training Online
Expiration Date
Chest Xray
Expiration Date
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13
Certification & Credentials
Enter All That Apply
Background Check
Expiration Date
Car insurance
Expiration Date
Care Giver Training Online
Expiration Date
Chest Xray
Expiration Date
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14
Certification & Credentials Continued...
Enter All That Apply
CNA Licence
Expiration Date
CPR Certification
Expiration Date
Driver's Licence
Expiration Date
First Aid Certification
Expiration Date
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15
Certification & Credentials Continued...
Enter All That Apply
HHA Certification
Expiration Date
LVN / LPN Certification
Expiration Date
Passport
Expiration Date
Performance Evaluation
Expiration Date
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16
Certification & Credentials Continued...
Enter All That Apply
State ID Card
Expiration Date
Tubercolosis Test
Expiration Date
Other - Describe
Expiration Date
Other - Describe
Expiration Date
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17
Employment History
Please provide Most Recent Positions Of Employment
Employer
Date Employed - Date End Employment
Supervisor's Name
Supervisor's Phone Number
Address Of Last Employer.
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18
Employment Number 2
Enter 2nd Employer If applies
Employer
Date Employed - Date End Employment
Supervisor's Name
Supervisor's Phone Number
Address Of Last Employer.
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19
Employment Number 3
Enter 3rd Employer - If applies
Employer
Date Employed - Date End Employment
Supervisor's Name
Supervisor's Phone Number
Address Of Last Employer.
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20
Professional References
Please provide Professional References...
Name
Phone Number
Name
Phone Number
Name
Phone Number
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21
Additional Information
What are your long-term dreams and aspirations? Please include both personal and professional goals.
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