We Care Assisted Living


Employment Application

Upon completion oft his application, you will be contacted within 1 to 3 days to proceed to the next step of the hiring process. 



Personal Information



First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
Title of Position Applying for?:
Date Available to Work:
Are you employed now?

YesNo
 If Yes, may we contact you present employer?

YesNo
 

Are you a United States Citizen or legally eligible to work in the U.S.?

(if hired, you will be required to provide documantation that you are eligible to work in the U.S.

YesNo
 Have you been previously interviewed or employed by We Care Assisted Living?
 If Yes, list date(s) and Job title(s)

YesNo
If Yes:
 Do you have any relatives currently working for We Care Assisted Living? If Yes, list names and relationship to you
YesNo
If Yes:
   
   
   Schedule of Availability 
Day Hours of Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
 
 
Education History                            
Name and Location # Years Completed Major Area of Study Degree/Diploma
High School
College
Graduate School
Technical or Certificate Program

       

References

(Please list names of supervisors, managers, or others who can comment directly on your abilities.)
Reference 1: Name / Address / Phone # / Relationship/Occupation / Years Known



Reference 2: Name / Address / Phone # / Relationship/Occupation / Years Known



Reference 3: Name / Address / Phone # / Relationship/Occupation / Years Known





Employment History

Please provide the following information for you previous three employers, beginning with the most recent.

Employer 1 


Employer:


Dates Employed: TO

Job Title:

Employers Number:

Address:( Street / City / State / Zip )


Job Duties:


Weekly Pay:
Start:Finish:

Reason for Leaving:


Additional Information:





Employer 2
Employer:


Dates Employed: TO

Job Title:

Employers Number:

Address:( Street / City / State / Zip )


Job Duties:


Weekly Pay:
Start:Finish:

Reason for Leaving:


Additional Information:




Employer 3

Employer:


Dates Employed: TO

Job Title:

Employers Number:

Address:( Street / City / State / Zip )


Job Duties:


Weekly Pay:
Start:Finish:

Reason for Leaving:


Additional Information:

Checklist For Applicants 
  1. Drivers License
  2. Social Security Card
  3. Lv 1 Background Check - from local sheriff's department $3 fee
  4. Any Training or Certificates - Training also provided in Office
  5. CPR Card if available
  6. Resume - needs to list 2 years caregiver experience - Per APD
  7. Current Car Registration
  8. Current Car Insurance Card
  9. 3 Professional / Personal References
  10. Must be able to Pass a Level 2 Background 
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