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Employment

Please fill out the application below to apply for employment with us. PLEASE USE A VALID EMAIL ADDRESS TO SUBMIT SUCCESFULLY; WE MAY RESPOND BY EMAIL. If you prefer, you can download the PDF application by clicking here, and print it. THEN fax or mail it.

Online Application Form

General Information

Fields marked * are required









Employment Information

List your job knowledge or skills in non-medical direct care
(example: bed baths,tranfers, ROM, bowel/bladder care)


List conditions you are familiar with
(ex: Alzheimer's Disease, Parkinson's, Spinal Cord Injury)


Employment information: List your last three Employer's Names
(Example: "Happy Homecare")


Business References: List three of your past/present supervisors and contact information


Schooling / Education: List all


Are you taking any medications that would inhibit your ability to care for others?


Tell us more about yourself:


Do you have any physical restrictions that limit your ability to lift 50 lbs, bend, walk, or clean a home?


Are you interested in being a part of our "Extra Services Team?" These jobs help us reach more people in the community.


In which if any of the following "extra services" do you have experience? (select all that apply)







Interview Questions

1. This position may require driving on the job. Do you have a valid driver's license, current insurance and working car today?



2. If your transportation fails, how do you plan to get to work?









3. Which of these best describes your thoughts about honesty? (select all that apply)







4. Which of these is true in your opinion? (select all that apply)





5. Which of these is true for you? (select all that apply)






6. Why do you think people steal?







7. Why do you think MOST PEOPLE go to prison?






8. Which of these statements BEST describe your views on theft?








9. This job may require decisions with money. How are you with money? (select all that apply)








10. Which of these statements describe you? (select all that apply)







11. Some CLIENTS may have challenging personalities. Which types of people would you find too difficult to work for? (select all that apply)















12. Finish this sentence: Elderly or disabled people...








13. Finish this sentence: If anyone is rude to me...







14. Ways that I try to save money include...








15. In spending time with clients on the job, you may have conversations about things you enjoy. Using your discretion, which of the following past times are appropriate discussion subjects or activities? (select all that apply)



















16. Reasons why I have called off work with less than 24 hours notice: (check all that apply)















17. Reasons why you have been late for work: (check all that apply)










18. Until what date (approx) were you last employed?



19. What was your last job and how did it end?


20. What did you like most about your last past job?


21. What did you like least about your last employer?


22. Finish this sentence:
When a co-worker or client tells me the latest complaint about another co-worker or office employee,...