Employment Application

If you need help filling out this application form or for any phase of the employment process, please notify the person who gave you this form. Please read the Applicant Note, Certification & Release and Restrictive Covenant at the bottom of the application before signing.

SECTION 1 - General Contact Info:

Name:

Address:

City:

State:

Zip:

Phone:

Email:

Are you a legal US citizen?:

Are you eligible to work in the US?

Do you have a Level II background check?

Social Security Number

SECTION 2 - Position & Availability:

Position applied for:

License number (if applicable):

Hours Available:

Desired Schedule:

Available for emergencies? (if applicable):


Are you available for a 24 hour live-in position? (if applicable):


Comments:

SECTION 3 - Education:

High School:

City/State:

College:

City/State:

Other:

City/State:

Degree(s) / Certification(s):

Special skills or training:

SECTION 4 - Experience (Caregivers only):

Please discuss any training or experience you've had with the elderly:

What do you enjoy most about working with the elderly?:

What do you like the least about working with the elderly?:

SECTION 5 - Employment History:

Current Employer:

May we contact your current employer:


Company:

Start Date:

End Date:

Job Title:

Reason for leaving:

Duties:

Supervisor:

Phone number

Current Employer:

May we contact your current employer:


Company:

Start Date:

End Date:

Job Title:

Reason for leaving:

Duties:

Supervisor:

Phone number

Current Employer:

May we contact your current employer:


SECTION 6 - References (Do Not Include Relatives):

Name:

Professional Relationship:

Phone:

Best Time to Call:


Name:

Professional Relationship:

Phone:

Best Time to Call:

SECTION 7 - Criminal History:

Have you ever been conficed of a felony or misdemeanor?


If yes, please explain:

SECTION 8 - Emergency Contact Information:

Name:

Relationship:

Phone Number (cell):

Phone Number (home):

Cover Letter:

Resume:

Applicant Note:

Sandcastle Homecare is an equal opportunity employer, dedicated to a policy of non-discrimination on any basis including color, race, ethnicity, national origin, religion, sex, gender, sexual orientation, disability, age or marital status. Additional testing for the presence of illegal drugs in your body may be required prior to, or during your employment with Sandcastle Homecare. All information on this application is confidential.

Certification & Release:

I certify that the above stated and indicated are true in fact and no misrepresentation of myself has been made. I understand that any false information, omissions, or misrepresentations of facts will result in rejection of this application and/or discharge at any time during employment. I authorize Sandcastle Homecare to verify any and all information contained within this application and, but not limited to, the AHCA Level II background check. I authorize all persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the illegal use of drugs is prohibited during employment and that I am willing to submit to drug testing at any time to detect the use of illegal drugs prior to or during employment with Sandcastle Homecare.

Restrictive Covenant

I agree to not do business directly with any individual or business that Sandcastle Homecare has introduced to me or by entering employment with such individuals or businesses.


Applicant's Electronic Signature:

Date: