Caregiver Application | WellSky Personal Care

Thank you for your interest in working for our agency.

Please submit the application below to be considered for a position as a caregiver.

Applicant Information:

First Name*:

Middle Name*:

No Middle Name:

Preferred Name:

Last Name*:

Address*:

Address Line 2:

City*:

State*:

Postal Code*:

Home Phone:

Mobile Phone*:

Email*:

Hours wanted weekly:

Date Of Birth:

Additional Information:

How did you hear about us? (Please indicate all referral sources and names if applicable):

Do you have a current credential (NAR/NAC, HCA, LPN, RN)?

Disclaimer:

I certify that the information given by me is true and complete to the best of my knowledge. I understand that if I am employed, the discovery that I gave false information during the application process may result in immediate dismissal. I authorize Advanced Health Care to investigate all statements contained in this application and to conduct a background check and request information about me from previous employers, educational institutions, and references. I expressly authorize my previous employers to provide information and opinions concerning my work and work habits. Further, I release Advanced Health Care and persons connected with any requests for information from all claims, liabilities, and damages for whatever reason, arising out of furnishing any information. If employed, I release Advanced Health Care from any liability for future references it may provide regarding my work history at Advanced Health Care. Due to the large number of applications that Advanced Health Care receives, I understand it cannot guarantee that my application will be considered for any or all open positions. In the event of employment, I understand that I am required to abide by all current and subsequently issued rules and regulations of Advanced Health Care and that any employment relationship with Advanced Health Care is of an “at will” nature. That means I can resign at any time with or without cause or notice and Advanced Health Care may terminate my employment at any time with or without cause or notice. Advanced Health Care is an equal opportunity employer.

Signature: