Application for Employment

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.

Luving Hands Home Care Application for Employment

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application.

Position applying for

Salary Desired

PERSONAL DATA

First name

Last name

Address

Phone

Driver’s License Number/State Issued ID

Social Security Number

Do you have a High School Diploma or GED?

Yes

POSITION INFORMATION

Check all that you are willing to work

Hours

Full Time

Part Time

Days

Evenings

Status

Swing

Graveyard

Weekends

Are you authorized to work in the U.S. on an unrestricted basis?

Yes

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.)

Yes

Explain:

Have you been told about the essential functions of the job or have you viewed a copy of the job description listing the essential functions of the job?

Yes

Can you perform these essential functions of the job with or without reasonable accommodation?

Yes

QUALIFICATIONS

please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training

Education

School Name 1

Degree/Diploma

Address/City/State

School Name 2

Degree/Diploma

Address/City/State

Other

SPECIAL SKILLS

List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.

REFERENCES

1. Name

Relationship

Address/City/State

2. Name

Relationship

Address/City/State

3. Name

Relationship

Address/City/State

WORK HISTORY

Job Title #1

Start Date

Month

Day

Year

End Date

Month

Day

Year

Company Name

Supervisor’s Name

Phone Number

City

State

Zip

Duties:

Reason for Leaving

Starting Salary

Ending Salary

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.

I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

Our Mission

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To provide high-quality, non-medical home care that enhances the quality of life for seniors and individuals with disabilities, and brings relief, confidence, and support to the families who love them.

Application for Employment

Luving Hands Home Care Application for Employment

PERSONAL DATA

POSITION INFORMATION

QUALIFICATIONS

Education

SPECIAL SKILLS

REFERENCES

WORK HISTORY

Our Mission

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