Join our family of compassionate caregivers and make a difference in the lives of others today! Take the first step towards a rewarding career by completing the form below.

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Step 1 of 12

Employment Application

All information entered is kept secure and confidential.

Name
Address
Checkboxes
Are you legally eligible to work in the US?
Are you available to work Call Outs, if needed?
Have you ever been employed at our company?
Do you have any friends or family employed at this location?

FYI: Conviction will not be a deciding factor in continuing the pre-screening process or potential employment opportunities.

Have you been convicted of a crime in the last seven (7) years?
During the hiring process, do you agree to provide a criminal background check?
During the hiring process, do you agree to provide a Motor Vehicle Record?

Educational Background:

Please Answer the Following Questions

List previous educational history.

 

GRADUATED
GRADUATED (copy)
GRADUATED (copy) (copy)
Document Checklist
Documents
Current
Expires

CNA Certification

Checkboxes

CPR/ First Aid

Checkboxes (copy)

Driver’s License

Checkboxes (copy) (copy)

TB Screening

Checkboxes (copy) (copy)

Employment Background

(You must provide at least 5 years of employment history)

References

List the name, relationship, number of years acquainted, and phone number of three references. (No relatives please).

Name
Relationship
Years Acquainted
Phone Number

Certification And Release

I certify that I have read and understand the application note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentation of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumers reporting bureaus, to verify any information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I understand that I am not obligated to disclose sealed or expunged records of conviction or arrest. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs before and during employment. Healing Haven Home Care is an equal opportunity employer. We strive to promote equality and diversity within the Agency, and this policy applies to all our employees, job candidates, volunteers, and contractors as well. Being an equal opportunity employer means we do not discriminate in employment on basis of nationality, color, sex, age, disability, religion, sexual orientation, and any other means as protected by all applicable state and federal laws.

Clear Signature
senior patient and the caregiver looking each other