Carefree Homecare Application for EmploymentLast 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?:
How many years of experience as a caregiver do you have?
Are you currently certified as a CNA? (not required for employment with our company)
Do you have CPR Certification?
Do you have First Aid certification?
Do you have a Fingerprint Clearance Card?
Do you have any other certifications or licenses?
If so, please list them in the space below:
Are you willling to work in Scottsdale, Paradise Valley and the
NE Phoenix area?
When can you start work?
Are you willing to work some weekends?
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 violiation?
If yes, please explain:
EMPLOYMENT HISTORY: Please list ALL PLACES OF EMPLOYMENT in chronological order, beginning with your current or most recent employer.
Job 1 Title:
Employer:
Address:
City:
State:
Phone Number:
Supervisor:
Dates Employed:
Reason for Leaving:
Job 2 Title:
Employer:
Address:
City:
State:
Phone Number:
Supervisor:
Dates Employed:
Reason for Leaving:
Job 3 Title:
Employer:
Address:
City:
State:
Phone Number:
Supervisor:
Dates Employed:
Reason for Leaving:
Job Title:
Employer:
Address:
City:
State:
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.
