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Apply to Become a Caregiver

Committed to serving our clients' unique care needs

At Care First, we know that happy, engaged and highly qualified employees is the number one ingredient for quality services. We know that taking care of our team benefits our patients and our community. Care First is proud to be an equal opportunity workplace and is an affirmative action employer.

If you would like to be considered for a caregiver position, fill out this online application completely. All applicants must have a minimum of 2 years of experience caring for an older adult in a private home setting. Should your qualifications and experience fit our needs and standards, we will contact you to schedule an in-person interview at our office.

  * denotes required fields

Personal Contact Details

Last Name*
  
Address *
 
Zip Code *
 

First Name *
   City *
  Phone *
  

Email Address *
  State *
 


Please answer the questions below.

Have you ever been convicted, pled no contest, or received deferred adjudication for a criminal offense including traffic violations?

Yes No

Are there criminal charges currently pending against you for any offense including traffic violations?

Yes No

If yes, please provide date of offense, city/county/state, nature of offense and current disposition.

Year

Year

Year

Offense

Offense

Offense

City/State

City/State

City/State

Note: Answering "yes" will not automatically result in the applicant being disqualified from employment and that qualification for employment will depend upon the nature of the charges and other information, such as the status of the proceeding and the underlying facts.

Are you authorized to legally work in the United States? *
Yes No

If you answered YES to the above question, which of the following applies to you:

  Citizen of the United States

  Lawful Permanent Resident (Green Card)

  Authorization to Work (Work Permit)

(NOTE: Proof of citizenship or immigration status will be required upon employment)

Employment History

#1) Current Employer

Position Held

Supervisor

Phone Number

From

Reason for Leaving

City/State

To

May We Contact Them?
Yes No

 

#2) Past Employer

Position Held

Supervisor

Phone Number

From

Reason for Leaving

City/State

To

May We Contact Them?
Yes No

 

#3) Past Employer

Position Held

Supervisor

Phone Number

From

Reason for Leaving

City/State

To

May We Contact Them?
Yes No

Education Background

High School

City/State

Did You Graduate?
Yes No

 

College

City/State

From

To

Degree(s)

 

CNA Program

City/State

From

To

Degree(s)

Employment Availability

When providing transportation to a client, are you comfortable driving your car? Yes No

Or driving your client's car?

Yes No

What hours are you available to work?

 

Morning

Evening

Overnight

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

How many hours per week are you able to work?

Are you available to work every other weekend?

Yes No

Desired Salary Range?

Agreement and Electronic Submission

Employment Eligibility: Immigration Act
I understand that, if hired, I will be required to present documentary evidence proving that I am currently authorized to work in the United States either by proof of US citizenship, Permanent Resident Card (Green Card) or Employment Authorization Card. I also understand that my continued employment is contingent upon my providing the necessary documentation within the prescribed timeframes.

Authorization and Understanding
I certify that the information given herein is true and complete without qualification. I understand that Care First will review the information given on this application and, if initial criteria are satisfied, will call me to schedule an in-person interview at the agency office. I understand and acknowledge that, if hired, Care First can terminate my employment if I have provided incomplete, inaccurate, untrue or misleading information on this application or on any other document or form at any time during my employment. I agree to conform to the rules and regulations of Care First and, if employed, I understand and agree that my employment is at-will and that no employment contract rights have been created. I also understand and agree that my employment may be terminated at any time with or without cause, and with or without advance notice at the option of either Care First or myself.

Full Name *:

Date *: (MM/DD/YYYY)

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