jobs

    • Personal Information
    • References
    • Educational Information
    • Work History
    PERSONAL AND GENERAL INFORMATION

    *Last Name

    *First Name

    Middle Name


    Address

    *Street No#

    *City

    *State

    *Zip Code


    Mailing Address (If Different)

    Street No#

    City

    State

    Zip Code

    Home Phone

    Cell Phone

    Message Phone

    *E-mail

    Are you 18 years of age or older?

    *List other names and aliases you have been known by

    Placement you are seeking

    *Hours preferred per week

    *Certifications/Licenses

     

    *Please include copy of any license(s) with your application

    Has your license ever been limited, suspended, or revoked

    Please explain

    Are you legally authorized to work in the United States on a permanent basis?

    If the answer is “no,” can you certify that if offered employment you can produce documents to establish your identity and that you are legally authorized to work in the U.S.

    Have you ever applied here before?

    Please give date(s)

    Do you have family members or friends employed at CaringGivers, LLC

    Please list names

     

     


    TRANSPORTATION

    Some clients require transportation. Do you have a current Driver’s License?

    Proof of auto insurance?

    PERSONAL REFERENCES

    A minimum of three (3) references, including complete mailing addresses, is required. Do NOT use family members or past supervisors.

    Name

    City

    State

    Zip

    Relationship

    Telephone

    Name

    City

    State

    Zip

    Relationship

    Telephone

    Name

    City

    State

    Zip

    Relationship

    Telephone

    EDUCATION


    Undergraduate / College

    Name of School

    Address of School

    Course of Study

    Years Completed


    Graduate / Professional

    Name of School

    Address of School

    Course of Study

    Years Completed


    Other – Specify

    Name of School

    Address of School

    Course of Study

    Years Completed


    SPECIALIZED EXPERIENCE, VOLUNTEER WORK, TRAINING/SKILLS

    Indicate months/years of experience for all that apply – for example

    Time Frame

    Time Frame

    Time Frame

    Time Frame

    TRANSFERS

     

    What work duties are you NOT willing to do?


    HOBBIES/INTERESTS

    Please list any skills, hobbies, or other activities that would contribute to your proficiency as a caregiver. Many 12- and
    24-hour jobs include considerable amounts of unstructured time, and leisure time participation with the client is important. Please indicate
    activities you enjoy and/or are able to teach to someone else.

     

     

     

    What meals do you typically cook at home?

    How would you rate your cooking skills?

    Are you comfortable cooking from scratch or do you prefer using prepared foods?

    How would you describe your personality (quiet, bubbly, humorous)?

    WORK HISTORY

    List present or most recent job first. Please fill in ALL areas requested.

    Employer

    From

    To

    Wage $

    Address

    Job Title

    City/State/Zip

    Job Duties

    Phone

    Supervisor

    Reason for Leaving:

    Explain Time Between Jobs:

    Employer

    From

    To

    Wage $

    Address

    Job Title

    City/State/Zip

    Job Duties

    Phone

    Supervisor

    Reason for Leaving:

    Explain Time Between Jobs:


    Employer

    From

    To

    Wage $

    Address

    Job Title

    City/State/Zip

    Job Duties

    Phone

    Supervisor

    Reason for Leaving

    Explain Time Between Jobs

    Please tell us about any caregiving experience you have that is not included in your work history. Also include how long you performed those tasks. (Example: Caregiving for parents or volunteer work.)


    AVAILABILITY Indicate (1) for first choice, (2) second choice; up to (5) in order of preferred shifts

     

     


    BACKGROUND Have you ever been convicted of a felony? (You need not disclose the conviction if the record of the conviction has been officially expunged)

    If "Yes", please explain

    A RECORD OF CONVICTION DOES NOT NECESSARILY DISQUALIFY THE APPLICANT FROM EMPLOYMENT CONSIDERATION, AND FACTS SUCH AS RECENCY AND REHABILITATION WILL BE CONSIDERED.

    I certify that all information on this Application for Employment and any other material provided by me is true and complete and understand that any misrepresentation of information or omissions may disqualify me from employment consideration and, if employed, will be considered grounds for dismissal whenever discovered.

    I hereby authorize CaringGivers, LLC to check with all persons, educational institutions, employers, and other organizations including, but not limited to, those named herein (and on my accompanying resume, if any) regarding any information provided herein, and hereby consent to their providing job related information about me.

    I understand that if I am hired, I will be required to conform to each of the policies and procedures maintained by CaringGivers, LLC. Further, I understand that CaringGivers, LLC follows an “employment at-will” policy, and that in the event I am hired, I or CaringGivers, LLC 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 the President of CaringGivers, LLC. I further understand that this Application for Employment is not a contract of employment, nor a contract with respect to the terms of employment.

    Applicant's Signature

    Date