Application

APPLICATION

Please submit an application below if you are interested in working for our company.

    Address:
    City:
    State:
    Zip Code:
    Experience:
    Alzheimer’s/DementiaHospiceIncontinence CareTransferringAmbulation AssistBathing/Shower AssistBed bathBed bound assistBoard transfersDressing AssistFeeding AssistGait BeltHoyer LiftHospiceIncontinence CareToileting AssistLight HousekeepingMeal PrepMedication RemindersOral Hygiene AssistShaving AssistOK with client’s who smokesOK with dogsOK with catsPACE
    Education:
    High School:
    Year Graduated:
    College
    Graduated?YesNo
    Vehicle Insurance
    Expiration:
    TB/Chest X-Ray
    Expiration:
    CNA License
    Expiration:
    CPR License
    Expiration:
    First Aid Certification
    Expiration:
    Driver’s License
    Expiration:
    Employment History:
    Please provide your most recent positions of employment.
    1.Employer:
    Phone:
    Supervisor:
    Address:
    City:
    State:
    Zip Code:
    Date Employed:
    From:
    To:
    2.Employer:
    Phone:
    Supervisor:
    Address:
    City:
    State:
    Zip Code:
    Date Employed:
    From:
    To:
    3.Employer:
    Phone:
    Supervisor:
    Address:
    City:
    State:
    Zip Code:
    Date Employed:
    From:
    To:
    Professional References:
    Please provide professional references.
    Name:
    Phone Number:
    Name:
    Phone Number:
    Name:
    Phone Number:
    How did you hear about A Care Partner?
    Current Employee
    Name:
    IndeedCraigslistFacebookLinked In
    Other
    Are you a US Citizen?YesNo
    If hired, can you provide proof of your legal eligibility to work in the United States?YesNo
    If no, please explain:
    Have you ever been arrested?YesNo
    If yes, please explain:
    Date :
    Reason or Charge:
    Parish :
    State :

    I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
    I understand to become an employee of A Care Partner, I must have a valid Driver's License, pass a background check and drug screen, and provide proof of citizenship in compliance with US form (I-9). Proof of citizenship can be shown by providing any one of the following: Social Security Card, Birth Certificate, or US Passport.
    By submitting this application, I authorize all former employers to release any and all employment information they may have about me to A Care Partner. I release all persons or companies from any liability or responsibility for providing such information.