Caregiver Job Application Flourish Supportive Living

  • AN EQUAL OPPORTUNITY EMPLOYER APPLICATION FOR EMPLOYMENT

    PRE-EMPLOYMENT QUALIFICATIONS

  • All applicants must: 1) be 18 years of age or older, 2) have a negative tuberculosis test, 3) undergo a criminal background check, and 4) have patience and compassion for people with dementia and traumatic brain injuries.

    In addition to the above, applicants for Resident Care Associate positions must also: 1) successfully complete a medication administration class (QMAP) approved by the State of Colorado, 2) complete a Colorado State approved first aid course, and 3) complete the additional questionnaire attached to this application.

    PLEASE NOTE: THIS IS NOT AN EMPLOYMENT CONTRACT. ALL employment opportunities with Flourish Supportive Living are “at-will” which means that you are not guaranteed any length of employment. If hired, either you or Flourish my terminate the employment relationship at any time, for any reason or no reason, and with or without prior notice.

  • Todays Date
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  • Have you lived in Colorado for the past 3 years?*

  • Employment Desired:

  • I am seeking:*
  • Can you work weekends?*
  • Can you work holidays?*
  • Do you have a current negative TB test?*
  • Do you have a current CPR certification?*
  • Do you have a current First Aid certification?*
  • I am vaccinated against COVID-19.  If yes, I have received the following doses: 1st, 2nd booster- maybe check boxes for these?*
  • If Yes - I have received the following doses.*
  • I am vaccinated against Influenza?*
  • I am vaccinated against Hepatitis B*

  • Education:

  • I have my GED
  • Graduated?
  • Graduated?*

  • Skills/Qualifications:

  • Current Employment:

  • Start Date
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  • May We Contact?

  • Previous Employment:

  • Start Date
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  • End Date
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  • Start Date
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  • End Date
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  • References:

  • Sign Application:

  • I certify that all information provided by me to the questions and statements contained in this application and other pre-employment forms are true and correct without consequential omissions of any kind whatsoever. I understand that falsification, omission or misstatements are grounds for refusal to hire or, if hired, dismissal.

    I further understand that I may be required to pass a medical examination (including a negative TB test) in order to qualify for employment, and I hereby authorize such medical examination.

  • Criminal Background and History Investigation Waiver

    In accordance with Chapter VII for Residential Care Facilities in Colorado, any staff employee who has direct personal contact with residents of a facility shall be of good moral and responsible character.

    In making such determination, Flourish may have access to and shall obtain any criminal history record information from a criminal agency, subject to restrictions imposed by such agency, and verify social security number and birth date for any person responsible for the care and welfare of residents in Flourish’s homes.

  • By affixing my signature below, I grant permission to Flourish Supportive Living to conduct an investigation into my background, confirm my social security identification and birth date, and call my references and former employers for purposes of this application.

  • Current Date
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