shamrock Carefree Homecare Application for Employment

Last Name:
First Name:
MI:
Phone Number:
Address:
City:
State: Zip:
Emergency Contact:
Relationship:
Phone Number:
   
Have you ever worked for or applied for work with Carefree Homecare previously?
How many years of experience as a caregiver do you have? 
Are you currently certified as a CNA?   (Certification is not required for employment with our company.) Yes No
Do you have CPR certification?  Yes No
Do you have First Aid certification?  Yes No
Do you have a Fingerprint Clearance Card?   Yes No
Do you have any other certifications or licenses?   Yes No

If so, please list them in the space provided below.
Are you willing to work in Scottsdale, Paradise Valley and NE Phoenix areas?   Yes No
When can you start work?
Are you willing to work some weekends?  Yes No
Type of employment sought:   
When are you available for work?    
Are you available for live-ins?
If so, what days?
What is the best way to contact you during the week? 
Have you ever been convicted of a crime other than a minor traffic violation?  Yes No
If yes, please explain

EMPLOYMENT HISTORY: Please list ALL PLACES OF EMPLOYMENT in chronological order, beginning with your current or most recent employer.

Job Title:
Employer:
Address:
City:
State: Zip:
Phone Number:
Supervisor:
Dates Employed:
Reason for Leaving:

 

Job Title:
Employer:
Address:
City:
State: Zip:
Phone Number:
Supervisor:
Dates Employed:
Reason for Leaving:

 

Job Title:
Employer:
Address:
City:
State: Zip:
Phone Number:
Supervisor:
Dates Employed:
Reason for Leaving:

Personal References

Name:
Phone Number
Name:
Phone Number
Name:
Phone Number

By submitting this information, I certify that all information is true and correct to the best of my knowledge and give Carefree Homecare permission to check all previous places of employment and references listed above.