Application EMPLOYMENT APPLICATION Applying online is quick and easy 1. START HERE, ONCE COMPLETED PRESS SUBMIT BUTTON AT THE BOTTOM OF THIS PAGE. Indicate whether you are applying for a Volunteer or Salaried Position(Required)VolunteerSalariedDate of Birth (Must be 18 to apply) * MM slash DD slash YYYY First Name(Required) Last Name(Required) Address(Required) Email Home PhoneCell PhoneSocial Security NumberDrivers License Number City(Required) Enter City Here If hired can you provide proof that you are legally able to work in the United States?(Required) Yes No How were you referred to us?AdvertisingPersonal ReferralEmployment AgencyWalk-inOtherHave you ever been convicted of a criminal offense; (felony or misdemeanor)? Note: An affirmation answer will not necessarily result in a disqualification for employment. Yes No If yes, please state nature of offense(s), Date(s), City(s), State(s), and disposition of the offense:II. Employment - Position Desired (Check all that apply)(Required) Personal Assistant Business Assistant Home Assistant Injury Assistant Parent Assistant House Cleaner Handyman Days and hours you are available for work?If necessary, are you willing to work overtime? Yes No Are you able to perform the essential functions of the position for which you are applying?(Required) Yes No If no was selected for the above questions, please explain why:How will you be commuting to a clients home?(Required) Car Bus Train Other When are you available to begin working?(Required)Immediately2 weeks1 to 2 months2 to 3 months3 to 4 monthsOtherDo you like working one on one with people?(Required) Yes No Are you available to work night(s)? Yes No Periodically If No, please explain.Please list the closest to furthest geological area in which you are willing to travel to see a client, starting with your closest town.In the Health Care field are you? (Check all that apply)(Required) Licensed Bonded Insured None Do you speak any other language besides English? If Yes, please list language(s).Are you CPR certified? Yes No Are you able to operate a Computer / Office machines? Yes No If Yes, what type of Computer software / Office machines you are proficient in?Do you have video calling? Such as a Skype, Facetime, Zoom or Duo account? Yes No If Yes, please provide your type of video calling account with your contact information.List any Business skills you may have.What knowledge, special skills and/or individual capabilities do you have, which prepares you for the position applied for?lV. Education: High School- List the Name & City of School / Number of Years Completed / Did you Graduate - Y/N ? Major Field(s) of Study?Education: College, University and/or Trade School- Name & City of School / Number of Years Completed / Did you Graduate - Y/N ? Type of Degree and Major Field(s) of Study?V. Employment History - Please account for all employment within the last two years. Begin with your current or more recent employer. Provide position Held/ Company Name/Address/Phone/Dates: From-To/Salary/Job Title/ Hours & Days Worked/Supervisor/Current employer: Can we contact employer? / * List your specific Job Duties. *(Required)ContinuedVl. Military Services - Have you obtained any special skills or abilities as a result of the services in the military that would be beneficial to the position you are applying for? Yes No If Yes, please describe.Vll. Personal References: Please list (3) people NOT related to you, which you have known for at least three (3) years. Include: Name, Address and Contact Number(Required)Read / Date / Submit(Required) Yes, I have read the Applicants Statement. Date MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM Can you Prepare Meals?(Required) Yes-Lunch No-Lunch Yes- Dinner No- Dinner Yes- Breakfast No- Breakfast Additional Comments PhoneThis field is for validation purposes and should be left unchanged.
