Caring Hands & More Application Form

Application Form

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age sex, religion, disability, medical condition, national origin, or marital status.

Office Location

Select Office Location

Personal Information

First Name *

Last Name *

Home Phone *

Work Phone

Mobile Phone

Email *

Address 1 *

Address 2

City *

State

Zip *

Driver's License Number

Section 1 - Work Interest

What type of employment do you desire? (required)

What position (s) are you applying for? (Home Care Aide/Direct Support Professional, Professional Cleaning, Lawn Care, Pet Care) (required)

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Monday-start and end times of availability (required)

Tuesday-start and end times of availability (required)

Wednesday-start and end times of availability (required)

Thursday-start and end times of availability (required)

Friday-start and end times of availability (required)

Every other weekend is mandatory. Are you able to work weekends? (required)

Yes No

Saturday-start and end times of availability (required)

Sunday-start and end times of availability (required)

Do you have a valid driver's licence? (Required for some positions.) (required)

Yes No

Are you willing to provide transportation for client errands? (required)

Yes No

Do you have daily access to internet? (required)

Yes No

Would you be willing and/or physically able to assist in bathing, toileting, grooming, and feeding a client? (required)

Yes No

Would you be willing and/or are you physically able to assist in cooking or doing light housework? (required)

Yes No

How did you hear about Caring Hands and More? (required)

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Section 2 - Work History

Are you eligible for employment in this country? (you will be required to provide proof) (required)

Yes No

Have you ever worked for Caring Hands & More before? (required)

Yes No

Current employer: (required)

Dates of employment (required)

Position held (required)

Brief description of duties (required)

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Reason for leaving (required)

Most recent previous employer:

Dates of employment

Position held

Brief description of duties

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Reason for leaving

Previous employer:

Dates of employment

position held

Brief description of duties

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Reason for leaving

Section 3 - Education History

Do you have a High School Diploma or a GED? (required)

Yes No

Name of high school attended

Name of college, vocational, or graduate college attended

Number of years attended

(Numeric Answer Only)

Major(s)

Degree(s) obtained

Section 4 - Background Information

Are you willing to undergo multiple background checks including a criminal record check? (required)

Yes No

If you answered no to the above, please explain.

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Section 5 - References

Please submit a professional reference (supervisor, co-worker, mentor, professor) Please no family or friends. Please state your professional relationship to them, a phone number and email to contact them. (required)

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I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

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