Caregiver Application | WellSky Personal Care

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*:

Location:

Hours wanted weekly*:

Date Of Birth:

Education & Training:

High School

College

School:

Degree received:

Employment History:

Please provide your most recent positions of employment.

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

Employer:

Supervisor:

Phone Number:

Address 1:

Address 2:

City:

State:

Postal Code:

Date Employed:

To:

+ Add Additional Employer

Additional Information:

What inspired you to apply?

Please list any volunteer work you have done.

Please list Emergency Contact Information (Include name, relationship, phone number.):

Caregiver biography (do not complete - internal use only):

Disclaimer:

I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired. I understand that upon extension of an employment offer, Seniors Helping Seniors, Greater Boston and Metrowest will conduct a pre-employment background check consisting of criminal record, personal and professional references, and a social media search. This acknowledgment serves as consent, subject to federal and state law and rights under the Fair Credit Reporting Act (FCRA).

Signature:

Thank you for your interest in working for our agency.

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

General

Pets