Employer Information

Caring About You, LLC
Telephone: 704-879-1037
Email: karen@cayhomecare.org

It is the policy of Caring About You LLC to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability, or veteran status.

Applicant Information

Applicant Full Name: *

Preferred Pronoun(s) *

Mobile Phone: *

Are you at least 18 years old? *

Yes

Do you have a valid driver's license? *

Yes

Home Address: *

City/State/Zip: *

Number of years at this address: *

Daytime Phone: *

Evening Phone: *

Job Position

Position Applying For: *

Home Healthcare Aid (CNA)

Companion Sittter

Full-time or Part-time? *

Full-time

Part-time

Either

Desired Hourly Rate/Salary *

How did you hear about us?

Do you have any friends or relatives who work here? If yes, please list here:

What shifts are you available to work?

1st Shift

2nd Shift

3rd Shift

Are you able to work weekends? *

Yes

If no, please state any limitations:

If applicable, are you available to work overtime? *

Yes

If you are offered employment, when would you be available to begin work? *

If hired, are you able to submit proof that you are legally eligible for employment in the United States? *

Yes

Have you ever been convicted of a felony or misdemeanor? *

Yes

If yes, what were you convicted of, on what date, and what city and state?

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

Applicant Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) that you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue the back page of this application.

Employer Name

Supervisor Name

Email Address

City/State/Zip

Job Title

Duties

Reason for leaving

Start Date

End Date

Employer Name

Supervisor Name

Email Address

City/State/Zip

Job Title

Duties

Reason for leaving

Start Date

End Date

Employer Name

Supervisor Name

Email Address

City/State/Zip

Job Title

Duties

Reason for leaving

Start Date

End Date

Applicant's Education and Training

College/University Name and Address

Did you receive a degree?

Yes

If yes, degree(s) received

Diploma Name and Address

Did you receive a degree?

Yes

Awards, Honors, Special Achievements

Military Service

Branch

Specialized Training

References

Name *

Email *

City/State/Zip *

Telephone *

Relationship *

Name *

Email *

City/State/Zip *

Telephone *

Relationship *

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer

Certification

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for the rejection of my application or, if employment commences, immediate termination.

I authorize Caring About You LLC to conduct a criminal background, contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Agency Director, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Caring About You LLC, except in a specific written contract of employment signed on behalf of the organization by its Agency Director, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION, AND I UNDERSTAND AND AGREE TO ITS TERMS.

Applicant Name as Signature *

Today's Date *

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