Careers - First Care Home Health

Position(s) Applying For: (please check all that apply)*

Certified HHA/CNA(75hr)

LPN

Physical Therapist

OT/ST

Home Care

Part-Time

Full-Time

Other/Specify

Clinical Applicants*

License Type

Date of Expiration

State

Number

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number(s)*

Email*

List best times to call*

Have you ever filed an application here before?*

Yes

If yes, give date*

Have you ever been employed by FirstCare before?*

Yes

If yes, give date*

Are you able to perform the tasks this job requires?*

Yes

If no, please explain*

Are you eligible for employment in this country?*

Yes

Have you ever had a criminal conviction?*

Yes

If yes, please explain*

Are you on a lay-off and subject to recall?*

Yes

Will you travel if job requires it?*

Yes

Can you meet the attendance requirements?*

Yes

Are you willing to work overtime?*

Yes

Have you ever been bonded?*

Yes

Are you CPR Certified?*

Yes

If yes, where and when*

Do you speak any foreign languages?*

Yes

If yes, please specify*

Do you have a reliable automobile?*

Yes

Do you have automobile insurance?*

Yes

If yes, give date*

Employment History

Please list your last four(4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in the comments below.

Employer

Telephone

Begin date

End Date

Address

Street Address City State ZIP Code

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Immediate Supervisor and Title

Job Title

Summarize the nature of the work performed and job responsibility

Reason(s) for Leaving

May we contact for a reference?

Yes

Employer

Telephone

Begin date

End Date

Address

Street Address City State ZIP Code

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Immediate Supervisor and Title

Job Title

Summarize the nature of the work performed and job responsibility

Reason(s) for Leaving

May we contact for a reference?

Yes

Employer

Telephone

Begin date

End Date

Address

Street Address City State ZIP Code

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Immediate Supervisor and Title

Job Title

Summarize the nature of the work performed and job responsibility

Reason(s) for Leaving

May we contact for a reference?

Yes

Employer

Telephone

Begin date

End Date

Address

Street Address City State ZIP Code

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Immediate Supervisor and Title

Job Title

Summarize the nature of the work performed and job responsibility

Reason(s) for Leaving

May we contact for a reference?

Yes

Educational Background

List the three (3) schools attended, starting with the last one first. List the number of years completed.
Indicate degree or diploma earned, if any. List your Grade Point Average or Class Rank.
Finally list your Major and Minor fields of study (if applicable).

Educational Background*

School

# of Years

Degree/Diploma

GPA/Class Rank

Major/Minor

References

List*

List name and telephone number of three (3) business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Name

Telephone Number

Years Known

List*

List professional, trade, business or civic associations and any offices. (Exclude memberships which would reveal sex, race, religion, national origin, age, color, disability or other protected status)

Organization

Offices Held

List special accomplishments, publications, awards. (Exclude memberships which would reveal sex, race, religion, national origin, age, color, disability or other protected status)*

List any additional comments or information you would like us to consider, including special skills and qualifications acquired from employment or other experiences that may qualify you to work with our company.*

How did you hear about FirstCare?*

Days and Hours available for assignments

Monday*

Tuesday*

Wednesday*

Thursday*

Friday*

Sunday*

Are you fluent in sign language?*

Yes

Are you fluent in any foreign language?*

Yes

If Yes, please list:*

It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed.

I give the Employer the right to investigate all references and to secure the additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

The Employer is an Equal Opportunity Employer, the Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state, or federal law.

This application is current for only sixty (60) days. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary to fill out a new application.

I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

By clicking Send Application, you acknowledge everything is correct.

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3901 Normal Blvd. Suite 102

Join Our Team

Employment History

Educational Background

References

Days and Hours available for assignments

Call US

3901 Normal Blvd. Suite 102

Join Our Team

Employment History

Educational Background

References

Days and Hours available for assignments