Before starting this Application, please have the following available for upload: Drivers License, Social Security Card, CPR / First Aide / BLS Certification, CNA / PCA / Caregiver Certification, TB Skin / Chest X-Ray, CoVID19 Vaccination Card (Not Required), and Valid Car Insurance. You will not be able to submit application without documents attached.
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FYI: Conviction will not be a deciding factor in continuing the pre-screening process or potential employment opportunities
List previous educational history
License Number and Expiration Date
If Vaccinated, please upload CoVID19 Card with other documents below.
List your previous employers beginning with the most recent employer.
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List the name, relationship, number of years acquainted, and phone number of three references. (No relatives please).
List the name, relationship, number of years acquainted, and phone number of three references. (No relatives please).
List the name, relationship, number of years acquainted, and phone number of three references. (No relatives please).
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 prior to and during employment. We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability, national origin, ancestry, veteran status, medical condition, sexual orientation, marital status or any other characteristic protected by applicable state or federal civil rights laws.
Sign your name here
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Upload a photocopy of your Driver license. If you're unable to upload document due to size, please email document to hr@anextrahandhomecarellc.com (Subject: Your Name / ID Verification Documents)
Upload a photocopy of your SS Card. If you're unable to upload document due to size, please email document to hr@anextrahandhomecarellc.com (Subject: Your Name / SS Card Verification Documents)
Upload a Copy of your CPR/ First Aid / BLS Certification. If you're unable to upload document due to size, please email document to hr@anextrahandhomecarellc.com (Subject: Your Name / CPR / First Aide / BLS Certification Verification Documents)
Upload a Copy of your CNA/PCA/Caregiver Certification. If you're unable to upload document due to size, please email document to hr@anextrahandhomecarellc.com (Subject: Your Name / CNA / PCA / Caregiver Verification Documents)
Upload a Copy of your TB Skin / Chest-Xray. If you're unable to upload document due to size, please email document to hr@anextrahandhomecarellc.com (Subject: Your Name / TB Skin / Chest X-Ray Verification Documents)
Upload a Copy of your CoVID19 Vaccination Card. If you're unable to upload document due to size, please email document to hr@anextrahandhomecarellc.com (Subject: Your Name / CoVID19 Vaccination Verification Documents)
Upload a Copy of your Valid Car Insurance. If you're unable to upload document due to size, please email document to hr@anextrahandhomecarellc.com (Subject: Your Name / Car Insurance Verification Documents)
Upload a Copy Resume. If you're unable to upload document due to size, please email document to hr@anextrahandhomecarellc.com (Subject: Your Name / Resume)