Are you currently caring for a client(family, friend or acquaintance) who is receiving service from another agency or from Helping Hands Caregivers? YES or NO. If yes, please let us know who you were referred by?

Have you provided Personal Cares for someone in the past? YES or NO. If Yes, please describe what you did for this person i.e. Note: no experience does not disqualify you from being considered for employment.

Please provide your birth date. :

Do you have any convictions affecting caregiver eligibility, such as battery, abuse, sexual assault, neglect or misappropriation? YES or NO. If yes, please explain.

Have you ever worked for Helping Hands Caregivers before? If so, when and what were your job duties?

By submitting this application online, I hereby certify that the information provided by me herein is true and complete. I acknowledge that any false or misleading information I provide herein or in an employment interview will be grounds to deny my application, or if discovered later, for immediate dismissal from employment. I authorize any use of the information contained herein by the employer for the purpose of verifying it. I authorize past employers, references and other persons to provide all information necessary to respond to any questions asked concerning my ability, character, and previous employment record. I release and forever discharge all such entities, persons and the employer from any and all liability arising from furnishing or requesting information about me. I understand and agree that if hired my employment will be at the will of both the employer and myself, and will be terminable by either, without notice, at anytime for any reason, expect as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president. If hired, I agree that any claim or lawsuit relating to my employment must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary.

I hereby certify that the information provided by me herein is true and complete. I acknowledge that any false or misleading information I provide herein or in an employment interview will be grounds to deny my application, or if discovered later, for immediate dismissal from employment. I authorize any use of the information contained herein by the employer for the purpose of verifying it. I authorize past employers, references and other persons to provide all information necessary to respond to any questions asked concerning my ability, character, and previous employment record. I release and forever discharge all such entities, persons, and the employer from any and all liability arising from furnishing or requesting information about me. I understand and agree that if hired, my employment will be at the will of both the employer and myself, and will be terminable by either, without notice, at anytime for any reason, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president. If hired, I agree that any claim or lawsuit relating to my employment must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary.