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Career
Think-Tank
FAQ
Home
About Us
Our Services
Why Us?
4-steps-to Care
Contact Us
Career
Think-Tank
FAQ
"We're Happy you Want to Join Our Team"
Please complete the
Application Form
below and
Send
when finish
Please provide all required information
Full Name- Family, Middle Initial & First Name
*
Date of Birth - only 18 years and older can apply
*
Last Four Digits of SS#
*
Contact Address
*
City, State, Zip
*
Mobile Telephone
*
Email
License Number / Certification
*
Are you eligible to work in USA?
*
NAMES, ADDRESS & TELEPHONE NUMBERS OF YOUR CURRENT & FORMER EMPLOYERS IN THE LAST 2 YEARS
Name of Employer
*
Name of Supervisor
*
Employment Dates
*
Address of Employer
*
Employer Telephone
*
Are you Still on the Job?
*
YES
NO
Briefly describe your duties, work experience and Job Title
*
Name of Employer before the current, if applicable
Name of Supervisor
Employment Dates
Address Employer
Employer Telephone
Are you still on the JOb?
YES
NO
Describe your duties,work experience and Job TItle
EDUCATION,TRAINING & DIPLOMA
Type of School
*
Foreign Education- Formal
High School
2-Year College
4-YearCollege
Business / Trade School
Professional
Name of School
Location & Address where Training was received
*
Degree / Certificate / Diploma / No Diploma
*
Dates of Training:
AVAILABILITY FOR WORK
Full-Time (over 30 hours per week)
Part-Time (20 hours per week or less)
Live-In (24-hour Service)
Providing Live-In relief
Providing substitue services paid by the hour
Working at Short Notice
WORK SCHEDULE- check day you are available to work
Available at all times
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Holidays
SERVICES & WORK EXPERIENCES- Please check areas of your experience
Bathing
Dressing
Feeding
Excercising
Persona Hygiene & Grooming
Transferring
Ambulating
Positioning
Toileting & Incontinence Care
Housekeeping
Medication Management
Meal Preparation
Laundry
Transportation
Making Telephone Calls
Shopping- Grocery & Personal Care items
Companionship
Hospital Bedside Assistance
PROFESSIONAL SKILLED NURSING EXPERIENCE- please check areas of your experience
Feeding Tube
Home Dialysis
Injections
Ostomy Care (e.g. colostomy, ileostomy)
Sunctioning
Tracheotomy Care
Urinary Catheter Care
Wound Care
Developmental Disabilities Care
Alzheimer's Care
Pakinson's Care
Dementia Care
Hospice Care
Diabetes
ABUSE INVESTIGATION
*
NO- I have never been investigated for Abuse, Neglect or Domestic violence
YES- I have never been investigated for Abuse, Neglect or Domestic violence
If Yes, Please Explain:
NAME OF REFERENCE (1)
*
Mailing Address
*
Telephone
*
Email
Relationship with Reference
*
NAME OF REFERENCE (2)
*
Mailing Address of Reference
*
Telephone Reference
*
Email Reference
Relationship with Reference
*
APPLICANT CERTIFICATION
*
I certify that all the information provided are accurate to the best of my knowledge. I understand that should I knowingly misrepresent information may result in rejection of my application.
Certification
*
YES
NO
SUBMIT YOUR APPLICATION
