Caregiver Application | WellSky Personal Care

Thank you for your interest in working for our agency.

Please submit the application below to be considered for a position as a caregiver.

Applicant Information:

First Name*:

Middle Name*:

No Middle Name:

Preferred Name:

Last Name*:

Address:

Address Line 2:

City:

State:

Postal Code:

Home Phone:

Mobile Phone:

Email*:

Location*:

Hours wanted weekly*:

Date Of Birth:

Education & Training:

High School

College

School:

Degree received:

Employment History:

Please provide your most recent positions of employment.

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

+ Add Additional Employer

Additional Information:

Are you at least 18 years of age?

Are you legally authorized to work in the United States?

Do you have any education or training beyond high school (college coursework, technical school, etc.)?

Do you have experience working with the elderly and/or disabled? If so, please explain.

Do you have an unrestricted driver's license and a clean driving record?

Do you have reliable transportation and valid automobile insurance?

Have you previously worked for Comfort Keepers? If so, which location?

Have you ever been convicted of/or plead guilty to a crime (other than minor traffic violations)? If yes, please explain (give date, location, charge, etc.):

Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodations? If no, please describe the functions that cannot be performed.

Are you able to lift up to 25 pounds?

We provide services 24 hours a day, 7 days a week (some weekends are required). Please list all days and hours of availability.

How did you hear about Comfort Keepers?

Disclaimer:

This application is intended for use in evaluating your qualifications for employment. All qualified applicants will receive consideration without regard to sex, race, color, age, creed, national origin, religion, disability, veteran status, uniformed servicemember, genetic information, or any other category protected by applicable federal, state, or local laws, regulations, or ordinances. No question on this application is intended to secure information to be used for such discrimination. COMFORT KEEPERS IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. EMPLOYMENT AT-WILL MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR THE EMPLOYEE MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. I certify that all the information on this application, my résumé, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate termination.

Signature: