Caregiver Application | WellSky Personal Care

Applicant Information:

First Name*:

Middle Name*:

No Middle Name:

Preferred Name:

Last Name*:

Address*:

Address Line 2:

City*:

State*:

Postal Code*:

Home Phone:

Mobile Phone*:

Email*:

Location:

Hours wanted weekly:

Date Of Birth:

Education & Training:

High School

College

School:

Degree received:

Employment History:

Please provide your most recent positions of employment.

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

+ Add Additional Employer

Professional References:

Please provide professional references.

Name:

Phone Number:

Name:

Phone Number:

Name:

Phone Number:

+ Add Additional Reference

Additional Information:

What is today's date?

Do you have your own dependable vehicle? ( including a valid drivers license & auto insurance) ? :

Reliability is key to being successful at Loving Arms Elder Care. Explain why you feel you are reliable?

Full-time employees are required to work every other weekend and rotating holidays. If applying for Part-Time are you available to work weekends? Yes or No:

We run an extensive background check on all applicants. Is there anything in your criminal or driving backgrounds that we may find? :

If yes, please explain nature and dates of conviction:

How did you hear about us, be specific (person's name, internet source, job search engine, school source, etc)?

Employment Desired: Full Time or Part Time:

What days and times are you available to work? :

Disclaimer:

I certify that all the information on this application and any other material provided in conjunction with my application is true and complete, and I understand that any misinterpretation or omission of information may disqualify me from employment consideration and will be considered justification for dismissal whenever discovered, if I am employed. I hereby authorize Loving Arms Elder Care to contact any persons, educational institutions, employers and other organizations including, but not limited to those named herein (and in my resume, if any) regarding any information contained herein or that may be relative to my employment, and I hereby consent to their providing job related or other relevant information about me and release the company from any damage or liability that may arise from the utilization of such information. I understand that if I am hired, I will be required to confirm to each of the policies and procedures maintained by Loving Arms Elder Care. Further, I understand that Loving Arms Elder Care follows an "employment-at-will" policy, and in the event I am hired, I or Loving Arms Elder Care may terminate the employment relationship at any time, for any reason, with or without prior notice, and that this "employment-at-will" policy cannot be changed unless the change is specifically authorized in writing by Loving Arms Elder Care. I further understand that this application is not a contract of employment, or a contract with respect to the terms of employment.

Signature:

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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