Caring Hands Inc – Employment Application

POSITION APPLYING FOR

Please select the position you are applying for:

If Other, Please Specify

PERSONAL INFORMATION

Name

First

Last

Phone

Email

Street Address

Address Line 1

City

State

Zip Code

ELIGIBILITY & WORK STATUS

Are you at least 18 years old?

Yes
No

Are you legally authorized to work in the U.S.?

Yes
No

Do you have a valid driver’s license?

Yes
No

Have you ever been convicted of a crime?

Yes
No

AVAILABILITY

Earliest Available Start Date

Employment Type

Full-Time
Part-Time
PRN

Available Shifts

EDUCATION

Highest Level of Education Completed

School / Degree / Years

LICENSES & CERTIFICATIONS

EMPLOYMENT HISTORY (MOST RECENT)

Employer Name

Employer Phone

Employer Address

Job Title

Dates of Employment (From – To)

Job disqualify) Please

Brief Description of Duties

Reason for Leaving

PROFESSIONAL REFERENCES

Reference 1

Name

Relationship

Phone

Email

Reference 2

Name

Relationship

Phone

Email

Reference 3

Name

Relationship

Phone

Email

BACKGROUND SCREENING CONSENT

I authorize Caring Hands Inc to conduct required background checks.
I understand employment may require background checks, reference checks, and verification of credentials in accordance with Maryland DDA requirements.

APPLICANT CERTIFICATION

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that false or misleading information may result in disqualification or termination of employment.

Applicant Signature

Clear Signature

Date

EQUAL EMPLOYMENT OPPORTUNITY DISCLOSURE

Caring Hands Inc is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected status. Completion of this section is voluntary and will not affect employment consideration.

Gender

Race / Ethnicit

Veteran Status

Providing this information is voluntary and will not affect employment consideration.

Disability Status

Providing this information is voluntary and will not affect employment consideration.

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Caring Hands Inc – Employment Application

POSITION APPLYING FOR

PERSONAL INFORMATION

ELIGIBILITY & WORK STATUS

AVAILABILITY

EDUCATION

LICENSES & CERTIFICATIONS

EMPLOYMENT HISTORY (MOST RECENT)

PROFESSIONAL REFERENCES

Reference 1

Reference 2

Reference 3

EQUAL EMPLOYMENT OPPORTUNITY DISCLOSURE

QUICK LINKS

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