Our agency is a full-service homecare agency that is licensed by the State Dept. of Health. We can perform all services with our models of care under our company roof. You will not have to hire different agencies. We offer different levels of care to meet your needs, including companion services, skilled care through our NYS LHCSA, and registry services.

Onondaga County: 315.447.2461 | Email

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ConstantCare247 is always looking for bright and talented individuals to be on our team and referral placement agency.

Employment Application

CONSTANTCARE 247, LLC

Employment Application
Licensed Home Care Services Agency (LHCSA)
Equal Opportunity Employer

Position Applying For (Check One):

Home Health Aide (HHA)

Personal Care Aide (PCA)

Licensed Practical Nurse (LPN)

Registered Nurse (RN)

Other

Date of Application

SECTION I - APPLICANT INFORMATION

Full Legal Name:

First Name

Middle Name

Last Name

Other Names Used (if any):

Address Line 1

Address Line 2

City

State

Zip Code

Phone/Mobile

SECTION II - AVAILABILITY

Days Available:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Monday Hours Available:

Tuesday Hours Available:

Wednesday Hours Available:

Thursday Hours Available:

Friday Hours Available:

Saturday Hours Available:

Sunday Hours Available:

Drivers License?

Yes

Reliable Transportation?

Yes

SECTION III - PROFESSIONAL LICENSE / CERTIFICATION

For HHAs / PCAs:

Certification Number:

Issuing Entity:

Date Issued:

Expiration Date:

For LPN / RN:

License Number:

State:

Expiration Date:

Has your license or certification ever been suspended, restricted, or revoked?

Yes

If yes, explain:

SECTION IV - EMPLOYMENT HISTORY

(List most recent employer first)

Employer Name:

Address Line 1

Address Line 2

City

State

Zip Code

Country

Position Held

Date Employed From:

Date Employed Until:

Reason for Leaving:

May we contact this employer?

Yes

Employer Name:

Address Line 1

Address Line 2

City

State

Zip Code

Country

Position Held

Date Employed From:

Date Employed Until:

Reason for Leaving:

May we contact this employer?

Yes

SECTION V - EDUCATION & TRAINING

Highest Level of Education Completed:

Relevant Training (CPR, Infection Control, Dementia Care, etc.):

SECTION VI - PROFESSIONAL REFERENCES

Name:

Phone:

Relationship:

Name:

Phone:

Relationship:

Name:

Phone:

Relationship:

SECTION VII - BACKGROUND CHECK NOTICE

As a Licensed Home Care Services Agency, ConstantCare 247, LLC is required under New York State law to conduct:

Criminal History Record Check (CHRC)
Home Care Worker Registry Check
License verification (if applicable)

Employment is contingent upon satisfactory results.

SECTION VIII - PHYSICAL & HEALTH REQUIREMENTS

If hired, you must provide:

Pre-employment physical examination
TB screening (PPD or IGRA)
Immunization documentation as required
Influenza vaccination or signed declination (if applicable)

SECTION IX - CERTIFICATION & AUTHORIZATION

I certify that all information provided in this application is true and complete to the best of my knowledge.

I understand that employment with ConstantCare 247, LLC is at-will and contingent upon regulatory clearance and background screening.

False statements may result in disqualification or termination of employment.

Full Name:

First Name

Last Name

Date: