The following information and documents are required for the PCA/CNA position at AT HOME CARE INC.

  1. $60 money order for background check
  2. Current Drivers License
  3. Social Security Card
  4. Current CPR and First Aid Certificate is required and if you do not have one, please go to www.nationalcprfoundation.com
  5. Current Auto insurance
  6. Current Auto Tag
  7. Current TB Skin Test
  8. Professional License plus 4 years of experience in the health care field if you are not a CNA.

WE CAN AND WILL PCA CERTIFY!!

APPLICATION FOR EMPLOYMENT
APPLICANT INFORMATION
First Name(Required)
Middle Name(Required)
Last Name(Required)
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SS#(Required)
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Mailing Address(Required)
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Marital Status:(Required)
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Employment Desired(Required)
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Are you a citizen of the United Stated?(Required)
Are you authorized to work in the U.S.?(Required)
Are you related to anyone who works this company?(Required)
Do you have a current driver’s license?(Required)
Address:(Required)
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EDUCATION
High School:(Required)
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Did you graduate?(Required)
College:(Required)
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Did you graduate?(Required)
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REFERENCES
PLEASE LIST THREE PROFESSIONAL REFERENCES NO RELATIVES
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PREVIOUS EMPLOYMENT
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May we contact your previous supervisor for a reference?(Required)
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Zip Code:(Required)
May we contact your previous supervisor for a reference?(Required)
Company:(Required)
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May we contact your previous supervisor for a reference?(Required)
MILITARY SERVICE
PLEASE READ CAREFULLY APPLICATION FORM WAIVER
In exchange for the consideration of my job application by AT HOME CARE, inc. (hereinafter called “the company”), I agree that: neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of the company, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the president/general manager of the company. Both the undersigned and the company may end the employment relationship at any time, without specified notice or reason. If employed, i understand that the company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.
I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the company permission to contact schools, previous employers, references, and others, and hereby release the company from any liability as a result of such contact.
I also understand that (1) the company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy.
I further understand that my employment with the company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the company is terminable at will for any reason by either party.
This company is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this company depends solely on your qualifications.
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OFFICE USE ONLY
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Clear Signature
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REFERENCE INQUIRY
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NAME OF APPLICANT(Required)
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AUTHORIZATION
hereby authorize At Home Care, Inc. to request verification of statement made by me on my employment application, and any other job related information. I also give permission to the Company addressed above to release information requested by At Home Care, Inc. I will not hold At Home Care, Inc. or the releasing company liable for statements made.
INFORMATION BELOW THIS LINE FOR OFFICE USE ONLY
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Is the above information correct?
If not, please make corrections.
Please select the appropriate answer for the following categories:
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Attendance
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Attendance
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Honesty
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Cooperation
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Dependability
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Initiative
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Courtesy
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Quantity of Work
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Ability to Learn
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Trustworthiness
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Would you rehire this applicant?
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Would you recommend that we employ this applicant?
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