Employment Application

* All prospective caregivers will take a short written test prior to their interview.

Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Certifications
- CNA
- NAR
- LPN
- RN
Other Credentials
- Nurse Delegation
- Nurse Delegation with Focus on Diabetes
- Mental Health
- Dementia
- CPR/First Aid
- Orientation and Safety
- Washington State Food Worker Card
- Other
Other Credentials
Please describe yourself*
Job Questions
Do you have a reliable way to get to work on time?*
- Yes
- No
Have you ever been convicted of a felony?*
- Yes
- No
Are you over 18 years old?*
- Yes
- No
Do you have experience using Microsoft Office (Word, Excel) or similar?*
- Yes
- No
Can you speak, read and write the English language proficiently?*
- Yes
- No
Are you legally authorized to work in the United States?*
- Yes
- No
Can you lift up to 50 lbs. without assistance?*
- Yes
- No
What do you think would be a good reason to be absent from work?*
What would be a reason for you to quit without notice?*
How do you handle people who are hard to get along with?*
What is your level of education?*
What was your last job?*
What were your duties at your last job?*
Please list two references with contact information.
Reference 1*
Reference 2*
Job Expectations/Availability*
Are there any medical condition that which may limit your ability to perform the job applied for?*
- Yes
- No
Please describe job hindering medical conditions.*
File Uploads
Please use this to upload all certificates along with your CPR and First Aid card.
Drop files here or
Please check the box below
Name
This field is for validation purposes and should be left unchanged.

* All prospective caregivers will take a short written test prior to their interview.

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Employment Application

Personal Information

Job Questions