Employment Application

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 - Transportation:

Valid driver's license number:

State:

Do you have a car?:


Make & Model:

Do you have valid insurance?


Proof of insurance:

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:

Certification & Release:

I certify the above 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 law enforcement authorities to release any information concerning my background & hereby release any said persons, schools, companies & law enforcement that i am willing to submit to drug testing at any time to detect the use of illegal drugs prior to or during my employment with Sandcastle Homecare.

Restrictive Covenant

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


Applicant's Electronic Signature:

Date: