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Application for Employment

PERSONAL DATA

Name
Address
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Do you have a High School Diploma or GED?

POSITION INFORMATION


(Check all that you are willing to work )

Hours
Status
Are you authorized to work in the U.S. on an unrestricted basis?
Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) Yes □ No If yes, explain:
Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job?
Can you perform these essential functions of the job with or without reasonable accommodation?

QUALIFICATIONS


Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.

REFERENCES


Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don't have three professional references, then list personal, unrelated references.

WORK HISTORY


Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS)

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Address

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Address

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Address

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Address
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BACKGROUND INFORMATION DISCLOSURE AND RELEASE


In connection with my employment application with Caring Hands Services, I understand that consumer reports which may contain public record information may be requested. These reports may include the following types of information: names and dates of previous employers, public records, credit data, bankruptcy proceedings, eviction and criminal records, etc., from federal, state and other agencies which maintain such records.
I AUTHORIZE WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY SINCERE SERVICES TO FURNISH THE ABOVE-MENTIONED INFORMATION.
I hereby authorize procurement of consumer and background report(s). I understand that if hired, this authorization shall remain on file and serve as an ongoing authorization for to procure consumer and background reports at any time during my employment.

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Caring Home Health LLC brings warmth, dignity, and meaningful support to every person we serve. Our team is committed to delivering care that feels personal, dependable, and truly life-enhancing. Whether you’re seeking guidance, daily assistance, or long-term support, we’re here to help you or your loved one live with greater comfort, confidence, and peace of mind.

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