Thank you for your interest in working for our agency.

Please submit the application below to be considered for a position as a caregiver.

Applicant Information:
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Match Criteria:
Indicate caregiver's skills and limitations. These will be used for matching the caregiver with clients.

General

Transfers

Pets

Education & Training:
Certifications and Credentials:
Please check all that apply, and enter the expiration date and any notes as applicable.
Active Type Expiration Date Notes
Car Insurance
CDP Certification
CNA License
COVID-19 Vaccination
CPR Certification
Driver's License
First Aid Certification
HHA Certification
LVN/LPN Certification
Performance Evaluation
Registered Nurse
ServSafe Certification
Tuberculosis Test

+ Add Additional Certification or Credential

Employment History:
Please provide your most recent positions of employment.

+ Add Additional Employer

Professional References:
Please provide professional references.

+ Add Additional Reference

Additional Information:
Disclaimer:
Stay Home Senior Services, Inc. is an equal opportunity employer. Stay Home Senior Services, Inc. does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Stay Home Senior Services, Inc. to hire me. If I am hired, I understand that either Stay Home Senior Services, Inc. or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Stay Home Senior Services, Inc. has the authority to make any assurance to the contrary. I attest with my signature below that I have given to Stay Home Senior Services, Inc. true and complete information on this application. No requested information has been concealed. I authorize Stay Home Senior Services, Inc. to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
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